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0281 WEST WIND CIRCLE - Health
/2,81 West Wind Circle Osterville A= 121 011 046 vaT Town of Barnstable Barn 04medcaCft .� Regulatory Services Department MRNSTATIU- Mass. 1639. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 6340 July 5, 2017 SYLVA, WILLIAM C &ROSE MARIE 8 MERRILL RD MERRIMACK,NH 03054 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 281 Westwind Circle,Osterville, MA was inspected on 06/19/2017 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes_" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Garbage disposal�must be removed with'permit. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH MVc ean, . ., CHO Agent of the Board of Health. Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\281 Westwind Circle Osterville.doc r 1FE A Town of Barnstable • �xxsrasc,E, Regulatory Services Department Public Health Division 200 Main Street;Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA. ❑Discharge or ponding of effluent to the surface of the ground w . ❑Pumping more than 4 times during the last year not due to clogged or obstructed Pipe = ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS,'cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no " acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official InspectionForm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments +. �M 281 Westwind Cir Property Address Rose Marie Sylva ; Owner Owner's Name , information is �4� required for every Osterville Ma . 02655 6/19/17 page. City/Town State Zip Code Date of Inspection ,1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information i1 filling out forms / /a qo T on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return key. Name of Inspector DiBuono Sewer and Drain reb Company Name 8 Johns path Company Address B S Yarmouth MA 02664 City/Town State, Zip Code 508-364-9587 S113522 "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 6/21/17 '`Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has al.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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 281 Westwind Cir ' Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 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: 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): Remove garbage disposal from kitchen sink t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 281 Westwind Cir Property Address Rose Marie Sylva. Owner Owner's Name information is required for every Osterville- - Ma 02655 6/19/17 page. Cityfrown 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 (cone.): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken.or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): Remove garbage.disposal from kitchen sink ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within.50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora a Subsurface"Sewage Disposal System Form - Not for Voluntary Assessments .'c 281 Westwind Cir Property Address Rose Marie Sylva - Owner Owner's Name information is required for every Osteryille Ma 02655 6/19/17 page. City/Town State Zip Code Date of Inspection y 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"aseptic tank and soil absorption system(SAS) and.the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form:' . 3. Other: f _ - 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 El 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 El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•''y 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No O Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: _. ❑ r- ® - - 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 ❑ O the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone,Il bf a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ElWere 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 forsigns of breakout? _ ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑. Existing information. For example, a plan at the Board of Health: ® ❑ . Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 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 W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Westwi i nd C r Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? - ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usa ,e d 153 Gpd 9 ( Y . 9 (gp )) Detail Sump pump?" ❑ Yes ® No Last date of occupancy: Date s . 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Four' Subsurface Sewage Disposal System Form- Not for Voluntary Assessments i} 281 Westwind Cir, Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17' page. Cityrrown State Zip Code. Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): YA General Information Pumping Records: 2015 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): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 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: A new pit was added in 1999 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line:. feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line. Septic Tank(locate on site plan): 1.5 Depth below grade: fee Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, l is't•age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of V Commonwealth of Massachuset ts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (coat.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 2411 311 Scum thickness Distance from top of scum to top of outlet tee or.baffle 42+1 Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 281 Westwind Cir Property Address , 1 Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. City[rown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M '281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 - 6/19/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution.Box(if present must be opened) (locate on site plan): i Depth of liquid level above outlet invert Level and at normal level 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.): Camera inspection to distribution box showed no signs of backup or failure at time of inspection ' i4 f{e I Y • . <. .,lei . ,.. .t, . .. ` 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: l5ins•3/13 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 c w 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 t ,r ❑ leaching chambers number: ❑ 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.): No ponding or break out 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 Sin - t s 3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts 7. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 281 Westwind Cir Property Address Rose Marie Sylva - - Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. Cityffown State Zip Code Date of Inspection D. System Information (cont:) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins-3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is Osterville Ma 02655 6/19/17 required for 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: 0 hand-sketch in the area below ® drawing attached separately _ .. i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 281 Westwind Cir. Property Address Rose Marie Sylva Owner Owner's Name information is required for every Osterville Ma 02655 6/19/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Siope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 15+ 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: USGS maps indicate NGW at 15ft Before filing this Inspection Report, please see Report Completeness Checklist on next page. t , t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 f 'Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION 7 Gv/N P _ �I £ ACE S S I WAGE# VILLAGH d S 7 M - ASSESSOR'S MAP&LOT I of D b &1S�A6I£R'S NAME&PHONE NO. try �F[NCn SEPTIC TANK CAPACITY _5 z/0Ti c— C 7/--iv LEACHING FACILITY:(type) (size) �. NO.OF BEDROOMS BUILDER OR OWNER P �/� V Q(U AUo 5 -PEPi FT DATE: X V b'-� COMPLLINCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility FerA Private Water Supply well and Leaching Facility Of any wells exist on sile.or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist wlthln 300 feet of leaching facility) Feet Furnished by t i � i P/ p,r �.�. y'J• t littp://www.townofbamstable.us/Assessing/HMdisplay,asp?mappar=121011046&seq=1 8/21/2015 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 281 Westwind Cir Property Address Rose Marie Sylva Owner Owner's Name information is Osteryille Ma 02655 6/19/17 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f , McKean, Thomas From: McKean,Thomas Sent: Friday, September 13, 2019 4:23 PM To: Flynn,Judith Subject: FW: 281 Westwind Cir Attachments: IMG_5112.JPG;ATT00001.txt Judith Please mark this one with the garbage disposal removed as "passed." All set. -----Original Message----- From.: William Ryzewski [mailto:swilly454@verizon.net] Sent: Friday, September 13, 2019 12:03 PM To: McKean,Thomas Subject:281 Westwind Cir CAUTION:This email originated from outside of the Town of Barnstable! Do not click links,open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 r i Town of Barnstable �FNE Tp� do Regulatory. Services. Thomas.F..Geiler,Director .sARNSCABM ► 9 . Public Health Division �Fp.N►p'�A Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax:..508-790-6304. October 4, 2006 Mr Peter Bounos 98 Bogle Street Westson,MA 02593 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located at 281 West Wind Circle,Osterville, MA was last inspected June 151h by, John A. Aalto, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Observed high static wastewater level due to uneven D-Box. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH EPARTMENT as A. McKean,R. ., C.H.O. Agent of the Board of Health ice ' • . Ln m r"Irl--' OFFICIAL C3Postage $ 0 Certified Fee M Return Receipt Fee /' AUGP, re2006 M (Endorsement Required) •�U r O Restricted Delivery Fee _p (Endorsement Required) J/ r-q G LISPS r-1 Total Postage&Fees ' Ln SentYT -- °— ----------- [ti Stn3et,Apt No.; nn OIi-BOX .� �' y„ City,State... ,ZIR+4 �G�- Certified Mail Provides: A mailing receipt (esjanay)zoozeunr'ooecwJqAsd o o A unique Identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery Information is not available on mail addressed to APOs and FPOs. `4 Town of Barnstable CF THE rp� P� do Regulatory Services + BARNSTABLE, Thomas F. Geiler, Director 9� MASS.. ,m� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 r Office: 508-862-4644 Fax: 508-790-6304 July 31, 2006 Mr. Peter Bounos 281 West Wind Circle Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 281 West Wind Circle, Osterville, MA,was last inspected on June 15'h 2006 by, James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Need to reset D-Box pipe in new pit. Box is not level You have 2 years from the_ date of the of the system failure to bring the system intyo compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. dBARNSTABLE H ALTH DEPARTMEN T Thomas A. cKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m , c DEPARTMENT OF ENVIRONMENTAL PROTECTION e i, SVOy ' 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 1A f D/l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 121—PARC 011046 Property Address: 281 WEST WIND CIRCLE OSTERVILLE.MA 02655 Owner's Name: BOUNOS,PETER Owner's Address: 98 BOGL,E STREET WESTON,MA 02493 Date of Inspection JUNE 15,2006 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes " Conditionally Passes Needs Further Evaluation by the Local Approving Authority . Fails Inspector's Signature: Date: '6-15-06 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.1.0,000 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 tot he buyer,if applicable,and the approving authority. Notes and Continents a NEED TO RESET D-BOX PIPE IN OTHER PIT. "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. SFZ 0L/ r,e Title 5 Inspection Form 6/15/2000 1 t � r ROB ' ,PTy 1/A3 e T ,� sU F��• ` 13o N pv j T U S 0 vS �� /'f�4A-CaS Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: JUNE 15,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A I have not found any information which indicates that any of the failure criteria described in 3 1.0 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 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&reset&line to other pit is piped into box.. ND explain: ; N/A 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 Healthy' pipe 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: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: TUNE 15,2006 C. Further Evaluation is Required by the Board of Health:N/A _ 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 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 wntl im a Zone 1 of 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: Tide 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: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: JUNE 15,2006 D. System Failure Criteria applicable to all systems: N/A 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 pits is less than 6"below invert or available volume is less than''/Z day flow, �— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis most be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CNIR 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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 CNM 1.5.304. 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: 281 WEST WIND CIRCLE OSTERVILLLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: JUNE 15,2006 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,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] 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: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: JUNE 1.5,2006 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Unknown Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): YES Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box;soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: AROUND 1985 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNDS,PETER _ Date of Inspection: JUNE- 15,2006 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 8" Materials of constriction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 8" Material of construction: �/ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 100-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 30" Scum thickness: F, Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17 How were dimensions deternuned: PLAN 7 TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of constriction: concrete metal fiberglass polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 t ' • Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 _ Owner: BOUNOS,PETER Date of Inspection: JUNE 15,2006 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.,): D-BOX IS 16"X 16"—T BELOW GRADE,BOX IS NEW—5/06. BOX IS NOT LEVEL NOTE:SYSTEM HAS(2)PITS,(1)PIT PIPED INTO BOX OTHER LINE CUT,NOT TIED IN. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): , Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): f 1 a i Title 5 Inspection Form 6/15/2000 8 I ' • Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 Owner: BOUNOS,PETER Date of Inspection: JUNE 15,2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Continents(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS(2)PITS,PITS ARE 2'BELOW GRADE. PIT(1)COVER AT 2"—PIT(2)COVER AT 10". BOTH PITS ARE DRY,SEASONAL USE. WALL CLEAN,NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionxlocate 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 constriction:, 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 Constriction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Title 5 Inspection Fonn 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 281 NEST WIND CIRCLE OSTERVI.LLE. MA 02655 ` Owner: BOUNOS, PETER Date of Inspection: JUNF. 15,2006 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 (00 feet. Locate where public water supply enters the building. ry CG Q / O 0 T ! 17 rti- O t� Tide 5 Inspection Form 6/15/2000 10 Page 1 1 of i t F ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) "` } Property Address: 281 WEST WIND CIRCLE OSTERVILLE,MA 02655 « Owner: BOUNOS.PETER Date of Inspection: JUNE 15.2006 ' SITE EXAM Slope Surface water Check cellar SIWIOw wells Estimated depth to no groundwater to feet r r - Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked.date of design plan reviewed: �- Observation site(abutting property/observation hole within 150 feet of SAS) Checked«ith local Board of}lealth-explain: Checked with local excavators,installers-(attach documentation Accessed USOS database-explain: You must describe how you established the high ground water elevation: ,F TEST HOLE ff NO WATER. , -------------- v//o.� 4 MJ wATrjZ i Title 5 Inspection Form 6/I5/2000 11 ti - ` %-'UNMUNWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL NMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTIO p1�© fir, TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address• e �• f ��� —' d✓/ —' O�� t Vv -t?, Owner's Name: Owner's Address: AA a Date of Inspection: Name of Inspector-Of ase rant ) Company Name: MaWng Address: ` i S - Telephone Number: 7100 f ;p _ �� � � CERTIFICATION STATEMENT C I certify that I have personally inspected the sewage disposal system at this address and that below is true,accurate and complete as of the time of the t the information reported training and experience in the proper function and inspection.The ' eP inspection was performed based on my approved system inspector pursuant to Section 1ST 4p of maintenance of g 310 3eWZge�o�systems.lam a DEP ( CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signatu • Date: �. The system inspector shall submit a co py of this inspection report to the A DEP)within 30 days of completing this inspection. If the system is a shared system or has a design Approving Authority(Board of Health or gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office DEP.The original should be sent to the system owner and copies sent to the buyer, flow of 10,000 authority. of the . Y ,if applicable,and the approving Notes and Comments �S ,1 ****This report only describes conditions at the timee otlns Inspection ���\� V time. This taspection does not address how the system will perform in the P on and under the conditions of use at that`" conditions of use. e future under the same or different Title 5 Inspection Form 6/15/2000 page 1 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: (`- Owner: Date of Inspection: Inspection.Summary: Check AjkC,D or E/ALW_AYa complete all of Section D A. System Pssseu . I have not found any information which 15.303 or in 310 CMR 15.304 exist An failre Cates that any of the failure criteria described in 310 CMR Y teria not evaluated are indicated below Commenb: a — C Of Cp 1 B. System Conditionally Passes: or more system components as described in the"Conditional Pass" repaired, tom, upon completion of the lac section need to be replaced or replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not (Y.N,ND)is the explain. for the following statements.If"not determined"please The septic tank is metal and o 20 years old"or the unsound,exhibits substantial infiltration o septic tank(whether metal or is structurally existing tank is replaced with a complyings tration or tank failure is imminent,Sys will ass e eP as approved by the Board o calf=, P inspection if the �A metal septic task will Pala inspection if it is strut indicating that the tank is less than 20 years old is availab Y sow,not leakin if a Certificate of Compliance ND explain: Observation of sewage backup or breakout or hi obstructed pipe(s)or due to a brok static water level , distnbution box due to broken or approval of Board of Health): 'settled or une distribution box.System ass inspection if(with broke ipe(s)are replaced o ction is removed istributioa box is leveled or replaced ND explain: . The system quired pumping more Shan 4 times a year due to broken or obstructed i e s . \ pass inspection i with approval of the Board of Health): P P OThe system broken pipe(s)are replaced obstruction is removed \ - ND explain: Tirin G inannr►inn pnrm!/1 annnn 2 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:'4-`6 LDS n S-1CC'J'� Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to de is failii to protect public health,safety or the environment. termine if the system 1. Sys m will pass unless Board of Health determines in accordance with 310 syste Is not functioning In a manner which win protect ubue heal R 15.30 l)(b)that the p P th,safety and environment: 1 or privy is within SO feet of a surface water _ Ces 1 or privy is within 50 feet of a bordering vegetated wetland or a marsh I System will fan unless Board of Health(and Pub lk Water uppuer, any)determines that the System Is functioning in a man that protects the public heal safety and environment: — The system has a septic surface waters y,soil absorption �pPY or surface water 1 tributary (SAS)and the SAS is within 100 feet of a butary to The system has a septic tank and S and is within a Zone 1 of a public water supply, — The system has a septic tank and SAS the SAS is within 50 feet of a private water supply well. The system has a septic tank and S and AS is less than 100 feet but 50 feet or more from a Private water supply well**. Method to de distance "This system passes if the well ter analysis,performe t a DEP certified laboratory,for coliform bacteria and volatile organic co unds indicates that the w is free from pollution from that facility and the presence of ammonia ni en and nitrate nitrogen is e A copy of the anal 9� or less than 5 .... provided that no other failure criteria are triggere analysis must be attac d to this form...:. 3. Other: T tla i inan..rtinn Fnrrn 4JI 411nnn 3 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP FOR ASSESSMENTS EC1'IO N FOR PART A M CERTIFICATION(continued) Property Address: r, �.c[ Owner: Date of Inspection: 0 D. System Failure Criteria applicible to all systems: You must indicab ems"or"no"to each of the following for all inspections:` Yes NP J BDackup of sewage into facility or system compom�due _hscharge or ponding of effluent to the �overloaded or clogged SAS or c clogged SAS or cesspool surface of the ground or Surface waters due to an overloaded,or — — Static liquid level is the distribution box above cesspool outlet invert due to anoverloaded or clogged SAS or Liquid depth in cesspool is less than 6"below invert or available o Required pumping more than 4 times in the last year N vohhahe is less than h day flow Pumped _Q�1 to clogged or obstructed pipe(s)•Number Any portion of the SAS,cesspool or privy is below hi �Y portion of high ground water elevation. wat"sply cesspool or privy is within 100 feet of a surthce water supply or tributary to a surface v Any portion of a cesspool or Any portion of a cesspool or Privy is within a Zone 1 of a public well. Any portion of a cesspool or��is within SO feet of a private water supply emu, Privy is less than 100 feet but greater than 50 feet from a private water. supply well with no acceptable water performed at a DU ce quality analysis. (This system Passes jt the well water analysis, rti$ed laboratory,for co bacteria and volatile organic compounds nitrogen that the well is 6"from pollution from that facility nitrogen sad nitrate is is equal to or less than 6 and the presence of ammonia are triggered.A copy of the analysis must be attached to this form J ppm,provided that no other failure criteria y (Yes/No)The system fails I have de described in 310 therefore determined that one or more of the above failure criteria exist as tr11sR 15will therefore the system f�,.�system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To considered a large system the system must serve a facility with a design flow of IO 0 gPd 00 gpd tQ 15,000 You must in ' ate either"yes"or"no"to each of the following; (The following c ' 'a apply to large systems in addition to the criteria above) yes no _ the system is within 40 t of a surface drizbng water supply the system is within 200 feet of a to to a surfac g water supply the system is located in a nitrogen sensitiv ea rim we Protection Area— Zone II of a public water supply we PNPA)or a mapped If you have answered"yes"to any on in Section E the system is consider "yes"in Section D above the I e system has failed.The owner or operator Bran 1 hgnificant threat,or answered significant threat under S on E or failed under Section D shall u of y system considered a 15.304.The system o er should contact the a appropriate Hate regional office ofthe p em in acc ` PP P gi ce with 310 C:Mlt epartment. 4 s OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSES "SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONS MENTS PART B FORM CHECKLIST Property Address: Owner. Date of Inspection: L 1 , Check if the following have been done.You must indicate es"or"no"as to each of the followin , Y/ No Pumping information was provided b the Owner,weer,occupant,or Board of Health Were any of the system components pumped out in the previous ta„oks? i _ Has the system received normal flows in the previous two week period? �L Ha large volumes f wateren introduced the system recently or as part of this ection?eST-CS- m p Were as built plans of the system obtained and )exarmiIIed?(If they were l not available noteas N/A) _._ Was the facility or dwelling inspected for signs of sewage back up? - — Was the site inspected for signs of break out? �L Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,o of the battles or tees,material of construction, wed'and interior of the tank inspected for the condition ` r dimensions,depth of liquid,depth of sludge and depth of scum? r J _ 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 Sail Absorption System(SAS)on the site has been determined b Yqs no aced 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 is unacceptable)[310 CMR 15.302(3)(b)j at issue approximation of distance Tifln C lncnan►inn �nnn A/1 i/7nnn _ 5 . `- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: 1�f�c,, r�2. Tu ✓� Date of Inspection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CWg 15.203(for example: 110 gpd x#of bedrooms): 3 L Number of current residents: U Does residence have a garbage grinder(yea or no)•ny i st onncC�'cU -�� L laundry on a separate sewage system ea or no•: � Laundry system i g Ys (Y ) LL4 [if Yes Separate inspection required] n(�'��}b� inspected(yes or no):]� S o f t h Seasonal use:(yea or no): Wad meter readings,if available(last 2 years usage(gpd));_� `A -c w,� Sump Pump(yes or no):�C7 Last date of occupancy:<l w,n CRLTDUSTRIAL T�'pe lishment: Design Sow on 310 CUR 15.203): snd Basis of design flow s ns/sgft,etc.): Crease trap Present(yea or no j Industrial waste holding tank present Non-sanitary waste discharged to iT 0-5 Sys es or no):_ Water meter readings,if ava' IE: Last date of occup e• escnbe): Pumping Records GENERAL INFORMATION Source of information: Mz S' Was system Pumped as Part of the inspection(yes or no):�p If yes,volume pumped: allons—How was Reason for pumping: gtity Pumped determined? r\e�,r— ��1` } TYPE OF SYSTEM y�Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DBP approval _Other(describe): Approximate age of all components,date installed if known i ,( end source of information: 17-11 Were sewage odors detected when arriving at the site(yes or no): Title � TncnArtinn Gnr.n�/�QI'7!1/�n 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEMASSESSMENTS INSPECTION FORM - PART C SYSTEM INFORMATION(continued) Property Address: 2. 'e cty- Owner: Date of Inspection: d BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 140 PVC_other(exp lain : Distance from private water supply well or suction line- Comments age,ebc ) Comments -C" diti o w ofjoin�, v`e deuce of leak .):�+ {v�r` \ oT � SEPTIC TANK:_(locate on site plan) Depth below grade: '��l,) Material of construction: concrete_metal--o�exp�) —fibaghm_polyethylene If tart is metal list age:_ Ia age confirmed by a Certificate of certificate) i Compliance(yes or no):_(attach a copy of Dimensions: X \ Sludge depth: __ Distance from top of sludge t ttom o out tee or baffle: 3` 11 Scum thiclmess:��P9 W �'�� e$ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of ou t tee orb q: - tic ►10 f tJe S How were dimensions determined: V't`n�cjP Comments(on pumping reco as relate too dons, inlet and outlet tee or baffle conditio utlet my rt,evidence of ea4ge,etc.): n'structural integrity,liquid levels r2 �1 U out Die GREASE TRAP:_(locate on site plan) Depth be de:_ Material of co don:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or Distance from bottom of scum to bottom of outlet tee or Date of last pumping: Comments(on pumping recommendati , ' et and outlet tee or baffle c 'tion,structural irate as related to outlet invert,ev of leakage, etc.): integrity, liquid levels r;Ho a r.,o..o,.;,.� c,....,�n�i�nnn 7 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FORM SYSTEM INFORMATION(continued)' Property Address:2 ( c Owner: 2 Date of Inspection: 2 TIGHT or HOLDING TANK: (tank must be Pined at time of inspection)(locate on site plan) ' Depth Material of cons tru concrete metal fiberglass_polyeth other(explain): Dimensions: Capacity: ¢allone Design Flow; ons/day Alarm present(yea . Alarm love• Alarm in working order(yes or no): Da -- P�ping:_ ommenta(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be o � Pened)(locate on site plan) • Depth of liquid level above outlet invert: Cakage i is(note if box is level and distribution to outlets equal,any evidence of solids carryover,�y evidence of leakage into or put of box,etc.): b C� c rcae. e. • P. CHAMBER: (locate on site pTanj Pumps in working order(yes or no): Alarms in working order e . Comme on Lion of pump chamber,condition of pumps and appurtenances,etc.): Ike I.;''c,s n`�' Ott� �oc �p5 rCIO zS "COGUe Fc-orY. b.(), t 1 : -e.,�c ����- , -F'��- 5- �;tip- c c.- QAck,t6) 1,.,G d is k ;� P `3 beC��oom i. .1 ovA- CT �V,� os bs06� Ti►In i /nrnorfinn Rnr+n F�l cnnnn - g �.,ve� `� r\e� OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FONTS PART C FORM SYSTEM INFORMATION(continued) Property Address 2561 Owner: w ` �' 2t Date of Inspection: p SOIL ABSORPTION SYSTEM(SAS): (lute on site plan,excavation not required) 9 ) If SAS not located explain why: leaching Pita,number: l leaching chambers,number L000 �c,lCo -4 0-Vin� leaching galleries,number: leaching trenches,number,length: leaching Seld%number,dimensions: overflow cesspool,member: innovative/aiternative system Type/name of technology: Comments(none condition of soil,signs of hydraulic etc.): failure,level of ponding,damp soil,condition of vegetation, �Ve Scusav�l' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site-plan N and configuration: ) Depth—t f liquid to inlet invert: Depth of soli er; Depth of scum Jaye . Dimensions of cesspoo , Materials of construction: Indication of groundwater inflo es or no): Comments(note condition of soil,A of hydraulic failure,level of g,condition of vegetation,etc.): PAY: (locate on site plan) Materials of construction Dimensions: Depth of solids: Comments(note cond' ' n of soil, signs of hydraulic failure,level of ponding,c ition of veg etation, etc.): T41. incnartinn V^-v'Ail f/')/1nn 9 Page 10 of i 1 , O FFICIAL INSPECTION F — O O. RM NOT FOR VOLUNTARY Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: C l' ,l�ckd C►`a-: owner. Date of Inspection: M 2 k J 0 SIZTCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent refamce lead_marks or benchmarks.Locate all wells within 100 feet Locate where public water supply eaters the building. 51 v� 0 C 3 L13 �y Z4 3 _ © d d� has sire - • - bye co 1��F se� +YX OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:'?- l Owner: �. 2 Date of Inspection: 6 S 2,1 4 b L4 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 14 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain.- Checked with local excavators,installe -( ch doeu�e�tatio Accessed USGS database-explain.- Yen must describe how you established the high groulm,4 water eleva on: T41. G incnar�inn Rnrm !./1 G/7l1M 11 J THE FOLLOWING IS/ARE TH-E-- BEST IMAGES FROM POOR QUALITY ORIGINALS) A- 1] -1 m /-�C& L DATA /f✓ w ` TOWN OF BARNSTABLE LOCATION l �e �,,,.rS - r SEWAGE # �C�= VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. Cc� � � 7 75 •� +.I Y SEPTIC TANK CAPACITY « w ftnrc, -� 6X6 PCt LEACHING FACILITY:(type) �� lT(t (size) 6)(b Eu a Ff NO. OF BEDROOMS PRIVATE WELL O UBLl WATER Nb BUILDER OR OWNER DATE PERMIT ISSUED: « �� DATE COMPLIANCE ISSUED ,�� VARIANCE GRANTED: Yes No N 4 V. 9 kINSSTALLERS TOWNOF BARNSTABLE0�-CATION �Q+� SEWAGE#LAGE QASSESSOR'S MAP&PARCEL NAME&PHONE NO. ?JOeA SEPTIC TANK CAPACITY 6 ' C— LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER V�\ 67-2_ i yy PERMIT DATE: O S 0 V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY a 37 3 _ 2 C.3 `-I3' .` TOWN OF`BARNSTABft LOCATION �`bl W2S'\ W�r�0 �, SEWAGE# 'V;ILLAGE O-;kC(','i ASSESSOR'S MAP&PARCEL WRTnr=NAME&PHONE NO. '�\d Q to S SEPTIC TANK CAPACITY t LEACHING FACILITY:(type) b 6 0 cA Q%r (size) NO.OF BEDROOMS rOWNER VMC— O"�� , �2rN COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY a t Yn-e w ;-� tJeus � ti ��orricC�leb A ,., o S j TOWN OF BARNSTABLE LOCATION O 0 4!a£;7- 4(//!L0 e/A SEWAGE# VILLAGE O S 7 ASSESSOR'S MAP&LOT I J Of 0JJ& /A/SPL'c oR IT'S NAME&PHONE NO. f6 tUIUCQ SEPTIC TANK CAPACITY /®� //// �/ LEACHING FACILITY:(type) (size) NO.OF BEDROOMS BUILDER OR OWNER 44EPA4I DATE: -:%-'� '® � COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t EAR o 13®x ?A/e+ � za r tj p / -r 2. -rAAI � o v No. _�wo`'(� 21 o • Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pp ration for �DizponY i§p$tem Cow5truction Permit Application for a Permit to Construct( ) Repair(JV) Upgrade( ) Abandon( ) ❑ Complete SystemIdIndividual Components Location Add s r Lot N CCC Owner'�ne,Add__resjj,a�nd Tel.No. gy/ JeST tnd, Assessor's Map/Parcel Z (vi I�e IhnslIns ller's Name, ddress,and Tel.No� -' f�� v� Designer's Nam Address and Tel.No. lcr's Name, Type of Building: „ Dwelling No,of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided and Plan Date Number of sheets Revision Date Title Size of Septic Tank _Type of S.A.S. 5 ' Description of Soil I Nature of Repairs or Alteration (Answer when applicable) j i Date last inspected: Agreement: The undersigned agrees to nsure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions o Title 5 of the Enviro ental Code and not to place the system in operation until a Certificate of Compliance has been issued by t is Boar of Health. Signed Date Application Approved by .,-Date. d 6 Application Disapproved by: Date for the following reasons Permit No. a 00 b y Date Issued S d �' f.lA f 210 � No. "- _ Fee O� • *� l/. t THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: Y— PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �Digogat 6pgtem ConkrUction Permit Application for a Permit to Construct( Repair(N) Upgrade( ) Abandon( ❑ Complete System Individual Components Location Add ss.or,Lot No. 1 Owner's Llame,Address Tel.No. Ma7f Assessor'sMap/Parcel PLI / Ins alter's Name,.Address,and Tel.No J jI 'C f� ` Designer's Name,Address and Tel.No. i Type of Building: Dwelling Bedrooms 1 e g N o o f Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ( ! Type of S.A.S. Description of Soil /y t Nature of Repairs or Alterationfs(Answer when applicable) Date last inspected: Agreement: P The undersigned agrees to'ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a`Certificate of ".� Compliance has been issued by this �Board (of Heal th. p /fir Signed \`t tJ}� L �t j -of( , Date ✓J (� Application Approved by� //1 ew. C Date w 6 Application Disapproved by. Date for the following reasons Permit No. Oo (y Date Issued . . THE COMMONWEALTH OF MASSACHUSETTS ���� BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired O Upgraded ( ) Abandoned( )by �)l Lf i at J at 4 V 1/( W ); f�l l� r L. r` tr ! `� has been constructed in accordance with the pro /viisions of Title 5 and the for Disposal System Construction Permit No. ?00� �P10 dated S-/S- O6 Inetall.er 4_ ,IZG/i`L�,p Designer #bedrooms _ Approved design flow gpd The issuance of this.p!ermit shall not be construed as a guarantee that the system�wil7}fu�aetirjl;us ''Rio ed. Date I_ /� _ Inspector --------------------------------------------- No. POO 1" d?�0 Fee / w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Digpool 6pgtem CZow9trUction Permit Permission is hereby granted to Construct ( ) Repair ( )� Upgrade ( ) Abandon ( ) �( System located at t / T and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special+conditions. Provided: Construction must be completed within three years of the date of thi permit I � J Date r5l �)(D Approved by 1v' ✓(M. S. r , TOWN OF BARNSTABLE LJCATION �i cc tJ C,�tnCJ C SEWAGE #tow VILi`,AGE C)�:,VrV k ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1ftmC 4- 6 6 LEACHING FACILITY:(type) dvfCkA Pft (size) 6)% W a siLv-3- UBLI WATER NO. OF BEDROOMS PRIVATE WELL O R BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No {� i. ._ y�,y.L,' ,J.; l . '► `� _ h �x � i' F�� t'� Lit No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diinpv!ml Workii Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair �an Individual Sewage Disposal System at: .................. __P......................................................... Ly ion .Address or Lot No. ............ ZZ-1.................................. ............................SQ ..................................................... Owner .............. ... ... ... dress Installer S Address < Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms......3--_----------_------------------Expansion Attic Garbage Grinder aOther—Type of Building ............................. No. of persons:-:____--___----__---------. Showers Cafeteria 04 Other fixtures ------------------------------------------------------------------------ ............................................................................ Design Flow................................ per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.$ ..gallons Length________________ Width__.-_..___--_-.- Diameter......_..___.... Depth...____.._...... Disposal Trench—No- -------------------- Width___-___.------______ Total Length....__._.___........ Total leaching area...................sq. ft. Seepage Pit No--------------_-__- Diameter.._..........______. Depth below inlet_....._..........._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date.-------------------------------------- Test Pit No. I................minutesperinch Depth of Test Pit----_-_______------- Depth to ground water_.__.................... fT Test Pit No. 2................minutes per inch Depth of Test Pit._..........____._.. Depth to ground water..__............._.._... P4 .......................................................................................................................................*------------* 0 Description of Soil........................................................................................................................................................................ U ......................................................................................................................................................................................................... ........................................ U Nature of Repairs or A1't'er'a"t-i'on"s—Answer---'''-...'----when--- '-'...applicable._.._.________'-------'-- '-- -A- .......... -------- ..... ----- ........... ......................................................................................................................................0........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has been iss ova d of health. ---- --------------------------------------------------------------- Signed ..... ............................ --------- am Application Approved By ............. ....... .... ..1Z. ............ ---- --------------------------------------- .....3kn-,9.,L-/....... Date Application Disapproved for the following reasons: ........................................................................................................................................ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .................. --------------- PermitNo. ..........7.L/---—---- ------------------ Issued -------------------------------------------------------- u D ............ Due j' LUf r>y� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App iratiun for Mnpunttl Warkii Towitrnr#iun 11rrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( V�an Individual Sewage Disposal System 4t: L ,} - -------------•••-•---- ---.......•. L c tion-Address or Lot No. a U_... ---------------------------------- --------------------------�c'n�e----.........._....--------------------••---••------- Owner Ad ress ----------------- Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___�-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------•----------••----•--•-------- .............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacityl+�.W__gallons Length________________ Width---------------- Diameter---------------- Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I________________minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 •-------•......................•-----------•----•-----------•---•----------••-••......•--•-•................................................................. 0 Description of Soil........................................................................................................................................................................ x U ..........................--•--••--•------•••-••-•••••-•-•-•---•••----••--••----•----•---.....•-----••----------•-------•-------•-••----••------•---•---•--•-••---•--•-•-•-----•--......-••-••......-•-- W •----•----•-----------------•--------------•--•-•---•--•------------- ---.....------------------------ x p � x� ` U Nature of Repairs or Alterations—Answer when applicable___________ _______________ --------6__._......-----�_�c��-----1..t.......... ---tom....... -�...... =-�.J'..................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beV d- the board of health. �� Signed ---------------------- .............. -- ...................................... If-TIC,--2 ------ Application Approved By --------------«/ V-'� Dace Application Disapproved for the following reasons- ------------------------------------ ............................................... . ............................... .................. ..._.... ..--............................................................ ............ . . . -- ..... �/ Dare Permit No- ------------fL/-------&-5-�—.�------------------ Issued . Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Telrt#ifira e of (gantylianee TH S IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� by .......... Ca�k----T�rzAA.tit- ---- --- ------_..------- � �nst:d�e� at . ��_..--....��.?C'S� .W�.- ... -�..r G�- � S -U'v0,`......2._ ........... .................. . .. . . has been installed in accordance with the provisions of TITLE 5 Qf The State_Environmental Code as described in the application for Disposal Works Construction Permit No. ._-.-. f'_y....-._��.. _ ....._. dated .__------------------_----_--------...-..-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION.SATISFACTO RY. DATE !<l.. - Inspector ... - _.. f` ------------------------------------------------------------------- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 TOWN OF BARNSTABLE No.....1..��..� :1. FEE. ..............� Diupnuul Workii Tunu#rnr#iutt Vrrntif Permission is hereby granted.......f:-- COA!;;S_re -....------------------------------------------------------------ - to Construct ( ) or Repair (k4 an Individual Sewage Disposal System atNo........ am......C\-c��e.............. ............................... ---------------------------------- Street as shown on the application for Disposal Works Construction Permit No.�'Z.-.�%-- Dated_._.._It- -.-_�......... (�DATE................ !.•...•........................ r ' Board of Health :••o---�=•-_•-'--�--%--�/-- v FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS �a. � F 7L O C A T ION / SEWAGE PERMIT NO. 11 TILLAGE I N S T A LLER'S Liez, NE i ADDRESS� tic) ® U I L D E R OR OWNER Cea~51 SQ Y-4Yh9Gar'.y1�i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED MaAA an, 67 .�o 1 L�f 37 qq No. .1 .............................. THE BOCOMMONWEALTHOF OF MASSACHUSETTS ARD HETH 2-....OF..... .......... ......... ....... Appliration for Dispostd Workii Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (_/_7 or Repair an Individual Sewage Disposal System at: ...U/J./V - - -71 1.........as-r .............P......... L _6.4..167 ------------ ti -A dress �rt No. 0 .................. . .......................... 0 ddress .............V.E! a..........a7i!5�17.%_ Ue ...1.011..... ..................... .xxw...I--- T11............................ Installer Address Type of Building Size Lot-----4r.62-J'Sq. feet U Dwelling—No. of Bedrooms-----------0-----3----_-_-------Expansion Attic Garbage Grinder Other—Type of Building P.W..-P.......�' . No. of persons...........j5............ Showers Other fixture ----------------------------I-------------------------------------------------------------------- Cafeteria ......................gallons per person per -------------gal�ons.,,,/Design Flow........._. 11 -------- fday. Total dail flow 1:4 Septic Tank—Liquid capacity.1410aallons Length---1-0-6... Width----F..... Diameter________________ Depth... 3.. W - Disposal Trench—No. .................... Width......../L.......... Total Length-___..........;,.._. Total leaching area....................sq. ft. Seepage Pit No---------I---------- Diameter---------- ------- Depth below inlet......4......... Total leaching area,..,//.,j,;7.sq. ft. Z Other Distribution box Dosing tqa�� ) -4 0 2! Jr1p.1 $/.Percolation Test Results Performed by ff. ... 664.C1111,et q�Date._..... =-,O... Test Pit No. I................minutes per inch Depth of Test Pit.........._._..._... Depth to ground water. O 1-.4 )V �Y4 Test Pit No. 2................minutes per inch Depth of Test Pit._.___._....__..._.. Depth to ground water. ._..._..............115je ----------- ....... .... ......... 0 Description of Soil................... ...... . . . .... U ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I'i lLj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the boar of heaw. ........... Signed- ..... ... &";,�""---------- Application Approved By............................................ ................................. ... ze_f.E.9...... Date Application Disapproved for the following reasons:......................................................................................... ...................... ........................................................................................................................................................................................................ Date PermitNo......................................................... Issued...................................................... Date N No................_....... ..,%Fps..........................._ THE COMMONWEALTH OF MASSACHUSETTS V BOARD OF HE TH Appliration for Dispaiaal Works Tonstrur#iun ramit Application is hereby made for a Permit to Construct ( 1 or Repair ( ) an Individual Sewage Disposal System at: 1� F cation Address p / / r,L�otr�N�ory, j p Owner .-, Address � Installer Address U Type of Building Size Lot.... .e/,�... J. Sq. feet Dwelling—No. of Bedrooms...........V,...3...................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Buildin 1 `�' rt�l�. No. of ersons....._..__ Showers — Cafeteria Other—Type g# P Otherfixture • ------•--•••-•-•---------•--------•---------••-•------------•---------. y--;-•--••-�--------••................. - ----------------------- Design Flow............. ... .....................'gallons per person pen d y. Total daily flow.._...... C..................... W - � � �- --- gal)onsy/ WSeptic Tank—Liquid capacity _+ gallons Length__f.0.6._.. Width._._.___.. Diameter----------------- Depth......3_. x Disposal Trench—No..................... Width.......p........... Total Length..................... Total,leaching area....................sq. ft. Seepage Pit No....._.._'..._....._ Diameter...____..-.---- Depth below inlet...... Total leaching area..4. J. -sq. ft. Z Other Distribution box (l ) Dosing tank ( ) Percolation Test Results Performed by._._..If.9. _ 6/..... &_6..CZ�W' Date......fa._."�_ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water ._..._. .r.. (_, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water___._..._ ! D Description of Soil..................1L....�-WI . ._...r ---•- �J )3 � � .. .... yf.. - -.... - x W U Nature of Repairs or Alterations—Answer when applicable._........................................................................................_...... ---•---------------------------------------•---------------•--------•.--------------......----•-•-•---....---------------------------------•----------•-----------------------------••-•---•-••--...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of heal.41 Signer`=:� A?........ Date Application Approved By.............................. .............................................................. ........................................ Date Application Disapproved for the following reasons--------------------------------•----•--•----••-•----------------------------------------.....--•••-•-••--------. ... -•----------••-••-•-----.....•--••-•-••••-•--••----------•-----••-•••------- ------------------------------------------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ' ...!41.: . ..OF....... .... '" ... ....... .. ............ Trr#ifiratr of Tout rliFanrr THIS IS TO CERTIFY, That the Individ al Sewage p}sposal System constructed 4.-) or Repaired ( ) �' . v Installer T_ r- - `(, = bpi''C ? ._ _ ,:2 n`1111 +� :..--: �'ls7t r ' has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........5....... ..:`_&.5............................. Inspector............ -- ............................................ THE COMMONWEALTH OF MASSACHUSETTS III BOARD OF HEALTH ......... A"' ,.Sr�:�l .......OF....... _.: c <r f ••-•• -llm No... --.�...16`. _ FEE........................ Dispasaal Vork.5 �� irnr inxa rrmi Permission is hereby granted------ 2----: 4... 6.4 to Construct �...�) or,Repair ( ) an Individual Sew ge Disposal S , tem Street as shown on the application for Disposal Works Construction Permit%;o.__----__---_---_- Dated.....................................:.... ...................-.. -------------- ................................................. v // Q Board of Health DATE ..... IJ............................... FORM 1255 A. M. SULKIN, INC., BOSTON -- - -- - 2A.L NOTE15 CLAW T" --AJL ESE%/. 15"o.A/+.3 AeE mrr.^..l SEA TESL BASQetA C]r.l 11 tY rT 5 t7Y►.TL�1.1 P1-A►.t�. PCicw ALL I.I W E!, A M I4j►"o"A OF AL-L- P►PES Tb A&J t.J TH£ SYSTEM SHAM r .... ` --, __—_____ AE CAST f@,C7►J 4� SC.��DUL.E �1�J P�/� '• � � n0 ALL 5 E?TIC -rew lcS oISTe IS�JT�aJ e.�, ,e.►�c� t_LrAC 1%" pCTS S►tra�� gE oES+G,aEo �7 o Q (� %4 - 20 v1.kEtt L O�.JC�S WHEN INSTALL.EPUNDER PAVING `y Zkmn,19 AL.L "r> E I► �/EQT E-EvV.A1Sr.�lo�r.ra13�oE MAETECCO O C) S 21 ►+lAlJL6.1 BPErr�SE�FoTeLI - / A eAaQS of /D Awjo 5ACe_F+L.I_ w lTM C"A,y cciE -- - ._--- -- 0 O C O ® o F otE,�,L-TI-4 "uST I Z NCST I F E� W H E�J T► E }" r � '1• C.C�If�.-E"T-IO►J b +tJ P��o2 Tp ps.c.kF'��_a_.+utw Zo �ZF �- o I j _J O ® O O � �/ O uu��5 OTLiEE'.�tSE t\1oTEQ, Ali SYSTEr� v c z ECT / Z V G o `' ro �' c COMf�1.1EtJ J t a►L4 ti'sE 1�S7A� cC� IwJ r t 1 /!C'�C•Ot12Dsw.JLEE. 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"' ro > pviI-T 4-W TO IL+ft'emff% ,i�to(A�� ,!'�: /Q►L> 1l/ G Neal/�{4ir 1�'UIl /Ak• Top ir QGLGr.J f 1"t5"or ew►tsw -WSI►e a I.,i►s•t F twttS►1 46ro`oe G�'IT- 1• I�eWSH CaCIrpC- ��5 Q/Et T►�+•EIL:+� 4 $ IIVIR`tl''C�lAcx U 4.E.�tHrt-1G i • 3" P4a.S'To..�E 46 INv- 414�Q (x� ® O r QLI�eE D wrotls ( QQ0 0 8 EPTIL "f<+I� ; '• .� ® 0 ,•0 v_*v v1 P,rr f / S Env =i+n 5V'STEM p'startL_I- . -led ; ' gJoT Ta SC.e.I t� L-E ACN IrJ& I TT I rxb CS. , 2 1 i ' MAP S A: 0,,ECTION PARCE4, /.O T S 4 _ i ffr„T C°"''r° PROPOSED PAR.1.ING I.00A TION � pe5/G/tiN C.2/TEel-4 o� My� I�O/bACO C�K/7aG6C i�H AlvA4 a EAe x oc sEO,�Q,M s - U�y� �x.�r �,.�- � r PROPOSED SE`VAGE PIVOSAI, SYSTEM << ROBERT t E .. / f} .1�' �/J� [7 T /�� J' 6rA1LGWS fE� it'C�aN ,oE?O� Y �' '� v RAYMOND �' Y/_ �/T • i'� ;''/ GPraGy/N6 eEQ u,r oes��e. car P r. � z��a O� c /,L 46A1 t Ni•VG v/opt --- �j Pr20P0S1£0 LEACHING PIT h f l ..ICr+./JT': Eut3tl.tts2: �L�-n�rv�s sT,4eceNST. A�� F_4G1NEt2trG INC. �-i�"� t�1�a Pp� a►.t' C 1 100 E x Nsti I.I s 10 nt � (ep�-FALI•iCL7T?••� H L G N�[/Ay I I �`' 61�E,4 T :: /V4P PR ROBE ���..1�►�icutr-1� 1+�.� 02s� RT � A E. '0 J t�. RAYMOND Aim c *HtKT 4: � T"oM AP C A rl X bid 19875 h 7L3 p 415 NOTEO J41NE // i 98•Q / OF 1 wd P�,.ICA.TI Q1Q, �- �) 54 ay p G, m owr rr: crrro >!r� wtrpo fir: PLANNo. �' 4 6T,5E" /s' eAY�I'QN. z