HomeMy WebLinkAbout0486 WIANNO AVENUE - Health 486 WIANNO AVENUE, OSTERVILLE
A= 163-015:
I
No. J l" l 3 Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE �-
2[p pricatiou jf or Yell Cou5tructiou Permit
Application is hereby made for a permit to Construct(t, Alter( ), or Repair( ) an individual well at:
Location-Address Assessors Map and Parcel
Owner Address
SO. 0V
Installer-Driller Address
Type of Building
Dwelling
Other-Type
��of Building No. of Persons
Type of Well 2� II 4D�,/� Capacity
Purpose of Well QQ 627471.DQ
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed C' oW
Date
Application Approved By
Dat
Application Disapproved for the following reasons:
Date
Permit No. wZ ( wU� Issued 2 �(
Date
------------------------------- --- —-- -----------------------------i
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( )
by
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
{
No. itj �01 1 003 `Fee
TOWN OF BARD OF NSTABLE
TNSTABc
O L E ��-
01ppYicatiou -for lVell Cougtructiou 3permtt
Application is hereby made for a permit to Construct(V),' Alter( ), or Repair( } an.individual well at:
,o-T 44M Lo wk)ti),g 4o n a b �
Location-Address Assessors Map and Parcel
Owner Address
Installer-Driller Address
Type of Building
Dwelling
Other-Type of Building No. of Persons
Type of Well ` %VC.e Capacity
Purpose of Well �� �i ( I; )i•,�
Agreement:
The undersigned agrees to install the afore described individual well in accordance with the provisions of the
Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the
well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed - � � i I i q
1 Date �
Application Approved By �/[ ? / //�/
Date/
Application Disapproved for the following reasons: -A,
Date
Permit No. oo3 Issued
Date
BOARD OF HEALTH �Jl
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( )
by
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Cou0tructiou permit
No. i x) 2° o3 Fee
Permission is hereby granted to —TP.,t lC ,f
Installer
.�,�,r:ram
to Construct Alter( ), or Repair Ol1n an individual`well at:
No. �(_.�' ( i/y.o.n�,„ A v v Of-T r✓y� /(k" .
f Street
as shown on the application for a Well Construction Permit No. jN .2 a 0 - Q(j 3 ,Dated
1
Date 2 �� // Approved By
J
Y ;1;
DATE::/,7;2/.9.6
PROPERTY ADDRESS: "%86 W anno Ave Caa.ret_a er_s cottage
1� 3/ Osterville
'Mass . ,
On the above date, I inspected the septic system at the above address. -
This system consists of the following:
1 . 61x6' 'bl.ock cesspool.
Based on my Insvectlon, I certify the following conditions:
1 . This not a title five 'beptic system...
2. Th r is a sewage. system
3. Cesspool is dry.
e sewa e s stem is in rq er workin ord. r
4. <� - � g . . Y . p p g � t
at the p'�gsent time. • '
51GNATUR!7,: `
Name: J_P_M_acomber Jr^ i �, 4
Company••_J.P_Macorgber & Son- ,Inc ..
-- •------ ----
Address:— -- --
CentelrvilLe LMass ' 02632 ' 19'9
Phone:--_5U,..j7.5_.333&------- , I .
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY'
I
. j
JOSEPH P. MACOMBER & SON,. INC. {
Tanks-Ceupools-Leachfields
a
Pumped & I'nsUlled
Town Sewer Connections
P.O. Box 66' Centerville, MA 02632-0066
I 77.5-3338 775-6412
D
3 Commonwealth of Massachusetts
Items
Executive Office of Environmental Affairs
Department of
Environmental Protection
W1111am F.Weld
60"Mor Trudy Coxe
LL��Praul Celluccl David B.Struhs
e
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A _
CERTIFICATION
PropertyAddresw 486A Wianno Ave Osterville
Date of Inspection: 2/12 9 6 Address of Owner.
Name of Inspector Joseph P. Macomber J r. (if different)
Company Name,Address and Telephone.Number.
J.P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338
CERTIFICATION STATEMENT
I certify that I have Personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
Fails l G�
Inspector's Blgnature: / ���� Date:
v
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design 110w of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A.B, C,or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303.
Any failure criteria not evaluated are indicated below. ,
B] SYSTEM CONDITIONALLY PASSES:
'6 O or more system components need to be;replaced or repaired. The system,upon Comp replacement or of the replaceme or repair,pass"
inspection.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If'not determined",explain-why not)
A44�. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,-or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as appro,,ed
by the Board of Health.
(revised 11/03/95) 1
One Winter Street 0 Boston,Massachusetts 02108 FAX(617)556.1049 0 Telephone(617)292.5=
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 486A Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date of Inspeotlon: 2/12/9 6
B)SYSTEM CONDITIONALLY PASSES (continued)
A-40 1bjA Sewage backup or breakout or huh static water level observed in the distribution boa is due to broken or obstructed pipe(s) �I
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced,
obstruction is removed
distribution box is levelled or replaced
d� The system required pumping more than four times a year due to broken or obstructed pipe(s). The will system Peas
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
---AM Conditions exist which require ti:rther evaluation by the Boatel of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS'NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT;
Cesspool or privy is within 50 feet of a surface water
d& Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
R) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
�Q The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
dW The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
AX The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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 Iris than 5 ppm.
S) OTHER
(revised 11/03195) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 486A Wianno Ave Osterville,Mass .
Owner. Robert Hall
Date of Inspection: 2/1 2/9 6
Dl SYSTEM FAIR:
I have determined that the system violates one or more of the following failure criteria es defined in 310 CMR 16.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the.
failure.
d[Q Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
jJ(Q Discharge or ponding of emuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Ab Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
�Q Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
d!U Required Pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
AQ Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
A& Any portion of a 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 I of a public well.
d(Q Any portion of a cesspool or privy is within 60 feet of a private water supply well.
d(Q Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
d f Q 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 lI of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into toll compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for Auther Information..
(revised 11/03/95) S
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddrem 486A Wianno Ave Osterville,Mass .
Owner. Robert Hall • ,
Date of Inspection: 2/1.2/9 6 e
Check if the following have been done:
,Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving norm flow rate
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
4/—As built plans have been obtained and examined. Note if they are not available with N/A
„JCThe facility or dwelling was inspected for signs of sewage back-up.
- The system does not receive non-sanitary or industrial waste flow
„ The site was inspected for signs of breakout.
,,,•,x All system components,ALding the Soil Absorption System,have been located on the site.
I�[Q The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of bafnes or
tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
, The size and location of the Soil Absorption System on the site has been determined based cn existing information or
approximated by non-intrusive methods.
, The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub.
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 486A Wianno Ave Osterville ,Mass ..
Owner. Robert Hall
Date of Inspection: 2/1 2/9 6
FLOW CONDITIONS
RESIDENTIAL; •
Design flow:_(;j6_gallons •
Number of bedroomall_
Number of current residents:
Garbage grinder(yes or no)-AL
Laundry connected to (yes or no):
Seasonal use(yes or no): iP�`'7 L/
Water meter readipp,if available: ;01�
i 4 VV,6 , 't Yi 6 r�1G r
Last date of oocupanry:L 2&WAJ
COMMERCIAL/INDUSTRIAL:-
Type of establishment:_
Design flow: gallono/day
Grease trap present:(yes or no)AY
Industrial Waste Holding Tank present:(yea or no).&Y
Non-sanitary waste discharged to the Title 5 system: (yea or no)."
water meter readings,if available: �J
Last date of oxupancy.
OTHER:(Describe)
Last date of occupancy: AM
GENERAL INFORMATION
PUMPING RECORDS OAd Soulys of' rmationp_��
System pumped as part of inspection: (yea or no)"/
If yea,volume pumped: gallons
Reason for pumping: d0Y'
TYPE OF SYSTEM
AM Septic taalr/distribution box/soil absorption system
Single owpool
A/y Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source of information: 16/li e. Gip,
Sewage odors detected when arriving at the site:(yea or no)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 486A Wianno Ave Osterville,Mass .
Owner. Robert Hall
Date of Inspection: 2/12/9 6
SEPTIC,TANxohwe- •
(locate on site plan) •
Depth below grade: _
Material of construction-✓ concrete_metal_FRP—other(explain)
A1,
Dimensions: AIR
Sludge depth:
Distance from top of sludge to bottom of outlet tee or bane::_
Scum thickness.. 0
Distance from top of scum to top of outlet tee or baffle:, A4
Distance from bottom of scum to bottom of outlet tee or baffle:_Alh
Comments:
(recommendation for pumping,condig''o°n of inlet and outlet tees or banes,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)' I!/Q LDA`J�1QP�iV r3
GREASE TRAP:
(locate on site plan)
Depth below grade:_Ag
Material of construction• concrete_m �etal FRP other(explain)
Dimensions:
Scum thickness: AIA
-Distance from top of scum to top of outlet tee or bane:-AL4
Distance from bottom of scum to bottom of outlet tee or bame:.412A
Comments:
(recommendation for pumping,condition of inlet and outlet tees or banes,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)_IV4
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddresm 486A Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date Of Inspeotloa:2 12 9 6
TIGHT OR HOLDING TANK:A� e ,
(locate on site plea) t
Depth below grader
Material of construction honcrete metal_FRP other(explain)
A
Dimensions: Ah9
Capacity:_ at A gallons
Design flow ns/day .
Alarm level: A1A
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
PJA rw.r�emT
DISTRIBUTION BOX:_AUe—
(locate on site plan)
Depth of liquid level above outlet invert: A4e
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
PUMP CHAMBER:"e,
(locate on site plan)
Pumps in working orden(yes or no)NA
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddrew 486A Wianno Ave �Osterville,Mass .
Owner. Robert Hall
Date of Inspection: 2/12/96
SOIL ABSORPTION SYSTEM(SASh
(locate on site plan,if pas excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain.-
Type:
leachin8 pits,number:
jo
leaching chambers,number..Q
leaching galleries,numbar._M
leaching trenches,numberlength:
leaching fields,number, nsions:
overflow cesspool,number.
Comments:( condition of soil,signs of hydraulic failure,level of pondiv&condition of vegetation,etc.)
A � t.��a�v75
CESSPOOLS:
(locate on site plan)
Number and configuration.•
Depth-top of liquid to islet invert:
Depth of solids9Depth
of scumDimensions of ol:Material of cotion
Indication of groundwater. 4jkule—
inflow(cesspool must be pumped as part of inspection)
Commen (note condition of ril,signs of�ydraulic failure level f ponding,condition of vegetation,etc.)
..l1� • tl1 �Oy a .,ram . Y
JV
PRIVY:Q
(locate on site plan)
Materials of construction: Dimensions:
Depth of solids:-AZ�
CO3"MentA (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95)• 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddreas: 486A Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date of Inspection: 2/12/9 6
SEMB OF SEWAGE DISPOSAL SYSTEM: •
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' 'j c,,ov WTu^
O
i
DEPTH TO GROUNDWATER
Depth to groundwater;!feet
waffluA of determination or
Le
OO
(revised 11/03/95) 9
rT
a•�enrn —n:rrr-•r•r:+srrr+rtsrn+nrnrta�rrrs*an:•f-rtarraarr*w+nn+sneoirro•satewas�
TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
v �r-•at��r•:::t-r..m-.err+mren-re.r:i�:rms+ts.e•Derrr:•rrnvsn�ae:r+ar�•++en�mre -e� tsmn :rrrr•rr--:r—r•
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 486A Wianno Ave 0sterville ,MaeG -
ASSESSORS MAP, BLOCK ,ATID PARCEL # //0 6 0 �LJ
•
OWNER's NAME Robert Ha71
PAR7' D - CERTIFICATION r
NAME OF INSPECTOR Joseph P. Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Rox 66 0entPrvi11P ,Macc _ n?O32
Street To" or City state LIP
COMPANY TELEPHONE (508 ) 775 3338- FAX ( 508 780 - 1578
CERTIFICATION STATEMENT
I certify .that I have personally inspected the sewage disposal system atl
this address and that the information reported is true, accurate, and
complete as of the time of .inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one:
XXX•XXXXSyste6 PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 - 303 . Any failure
criteria not evaluated are as stated' in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have conducted has found that .the system fails to
protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 30.3, and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature /:
Date
• __ -
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable) and the DOARD OF HEALTH.
* If the inspection FAILED, th"e owner or operator shall upgrade ' the aystem
within one year of the date of the inspection, unless allowed or required
otherwise as provided in 310 CHR 15 , 305 . '
l
W
torri
�7
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P.-,Macomber, Jr.
Has satisfied the .Department's qualifications.as required and-is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided M" 310 CMR 15.340 -and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
June 8. 1995
' Acting Director of the ' ion of Water Pollution Control
f
y
DATE:_'2'/._9/.96 .
PROPERTY . ADDRESS: 4,86 Wianno A've
1 �-3 Osterville
C Mass . •
On the above date, I inspected the septic system at the above address.
This system consists of the following:
1 . -1-61x10l Fieldstone cesspool.
1-61x8l Concrete Block cesspool.
•1-1000 gallon leaching pit packed in stone.
Based on my Insnaction, I certify the following conditions:
1 . This is not a title five -septic sya em
2. Th-1T 'is' a sewage- sytem. ( Cesspool sytem with leach pit )
3. The sewage system is in proper worl£.ing order at ,they
present time. .
SIGNATUR!-:
Name J P Macomber Jr...
J. P,Macomber & Son• *Inc .
FF
Company:--------------------
B2
Address:
1996
Centerville Aq_ps '_0.2.632
Phone:___548.,.Z7.5,.3338--__ -- - t
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOS]E366'
P. MACO11 ER & SON, INC.
Tanks-Cesspools,-L0 hileIds
Pumped lnstsIled
own Sewer Connections
P.O. Centerville, .MA 02632-0066
775-3338 775-6412
Commonwealth of Massachusetts
7*QM=tj
Executive Office of Environmental Affairs
Department of
Environmental Protection
William em" F.WeldC3o Trudy Cox*
A coo Paul Cellucci �wy
David B.Struh:
e �
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PropertyAddreae: 486 Wianno Ave Osterville ,Mass . Address of Owner.
Date of Inspection2/9/9 6 (It different)
Name of Inspector.. Joseph P. Macomber Jr.
Company Name,Address and Telephone Number.
J.P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632
CERTIFICATION STATEMENT 508-775-3338
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
. e Passes
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails J�
Inspector's Signature: /%%6�iL�y(/�1�� Date: p7+f 7"V
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner&hall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B,C,or D:
A] SYSTEM PASSES:
_ I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 Clffit 15.303.
Any failure criteria not evaluated are indicated below.
BJ SYSTEM CONDITIONALLY PASSES:
)n One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,pas&es
inspection.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instance&. If"not determined",explain why aotj
_. The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exiiltration,.or tank failure is
A)Md" iauninent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street * Boston,Massachusetts 02108 Is FAX(617)556-1049 * Telephono(617)29 _wW
i Printed on RttycW Papa
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A .
CERTIFICATION(continued)
Property Address: 486 Wianno Ave Osterville,Mass .
Owner. Robert Hall
Date of Inspection: 2/9/9 6
BJ SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or 0 static water level observed in the distribution boat is due to broken or obstructed pipe(s)
or due to a broken,-settled or uneven distribution boat. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required Pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
AM Conditions exist which require iiuther evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.
&V Cesspool or privy is within 50 feet of a surface water ;
A& Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
i
Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
Q� The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
�Q The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well.
The system has a septic tank and soil absorption system and is Ins than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis 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 6 ppm.
9) OTHER
f C _
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 486 Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date of Inspection: 2/9/9 6 ,
DI SYSTEM FAILS: s .
A10_ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified!below. The Board of Health should be contacted to determine what will be necessary to correct the.
failure.
d19 Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of efllucnt to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Ago �px Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is Is"than 6"below invert or available volume is less than 112 defy flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
�Q Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
AV Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
AM Any portion of a cesspool or privy is within a Zone I of a public well.
�Q Any portion of a cesspool or privy is within 60 feet of a private water supply well.
jQ Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
�Q The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
(2 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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for Auther information..
(revised 11/03/95) 3
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddresu 486 Wianno Ave Osterville,Mass .
Owner. Robert Hall e
Date of Inspection: 2/9/9 6
Check if the following have been done:
ZPumping information was requested of the owner,occupant,and Board of Health.
2None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection
_Ie As built plans have been obtained and examined. Note if they are not available with N/A
, The facility or dwelling was inspected for signs of sewage back-up.
, The system does not receive non-sanitary or industrial waste flow
, The site was inspected for signs of breakout.
ZAll system components,including the Soil Absorption System,have been located on the site.
NO VAX The septic tank maaholee were uncovered,opened,and the interior of the septic tank was inspected for condition of banes or
tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.
ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub.,„
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 486 Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date of Inspection: 2/9/9 6
FLOW CONDITIONS
RESIDENTIAL: s
Design mow:/Rl D pnons pd.-da y
Number of bedrooms:
Number of current residents: d
Garbage grinder(yes or no).A
Laundry connected to system(yes or no):)�
Seasonal use(yes or no):A—s
We reaoingl,if aval le: 166iffigAlLut, = r/ &o t7 19f
>4
Last date of occupancy&- &W.V i�
COMMERCIAL/INDUSTRIAL-
Type of establishment: AIR
Design flow N4 ganons/day
Grease trap present:(yes or no)_4
Industrial Waste Holding Tank present:(yes or uo).AM
Non-sanitary waste discharged to the Title 5 system: (yes or no) &W i
Water meter readings,if available:_ ll
Last date of occupancy:_&H
OTHER.(Describe) Q �wmoitp tx-,kao2 lave
Last date of occupancy: ,QG TU t�4 t y�I
GENERAL INFORMATION
PUMPING,$ECO 3 andinf, tion: _,n�
f ,3-
System pumped as part of inspection:(yes or no) SY 97e- --,
If yes,volume pumped: ons
Reason for pumping
TYPE OF SYSTEM
4/0 Septic tank/distribution boa/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yesD Other(explain) f 6or no) (it yea, p ous ' Faction records,if any) G
A( S e,�
PRO TE AGE of all components date inst,%Ued(if known)and source of informa on ( njJSv�PC-
>Neg74*9.w4 IV-i-4/ fir m is - 1;- 9 I -q'b -
Sewage odors detected when arriving at the site: (yes or no)A&
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddrea: 486 Wianno Ave Osterville ,Mass .
Owner. Robert Hall
Date of Inspection: 2/9 9 6
SEPTIC TAN&.&kNe-
(locate on site plan)
Depth below grade:,Q fl
Material of constructio • concrete metal___FRP_other(eiplain)
Dimensions: JUA
Sludge depth: AL&
Distance from top of sludge to bottom of outlet tee or baMe:A&—
Scum thicfoess:_��
Distance from top of scum to top of outlet tee or baffle: yoA
Distance from bottom of scum to bottom of outlet tee or bafae: 03
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baf(Les,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)- Al& (`QYV-, EA3TS
GREASE TRAP:_Qo*L
(locate on site plan)
Depth below grade:,k A
Material of construction:&Wooncrete_metal_FRP—other(explain)
--IdA
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet toe or bafne:la—
Distance from bottom of scum to bottom of outlet tee or baffle:1)fl—
Comments:
(recommendation for pumping,condition of inlet and outlet tees or bafnes,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leafage,etc.) T1 b QZNh1Me_A7r5j
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 486 Wianno Ave Osterville,Mass .
Owner. Robert Hall
Date of Impaction: 2/9/9 6
TIGHT OR HOLDING TANK-AJ PVe, • ,
(locate as site plan) •
Depth below graade:,
Material of constructs mkaconmvt•_metal_PW_otber(esplain)
Dimensions: A9la
Capacity:- N R gallons
Design flow:_ ns/day
Alarm level:
Comments:
(condition of islet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BO&.J�bb)q
(locate on site plan)
Depth of liquid level above outlet invert: Al�i
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
k)+ fiv►nvV1 TS.
PUMP CRAMBER:JIWp„
(locate on site plan)
Pumps in working o:der:(yes or no)„ALJ
Comments:
(note condition if pump chamber condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
ProPertyAddress: 486 Wianno Ave Osterville,Mass .
owner. Robert Hall
Date of InspeoUon: . 2/9/9 6
SOIL ABSORPTION SYSTEM(SAS);_Z
(locate on nice plan,it poss3b]e;excavation not requir:d,but may be approximated by non-intrusive methods) ,
If not determined to be e present,explain:
Type,
lesching pits,number.j
leaching chambers,number.•
leaching galleries,number.,
leaching trenches,number,leagth
leeching fields,number,dimensions•
overflow cesspool,numben—a
Comments:(note condition of soil,signs of hydraulic failure,level of Pondd� ,condition of vegetat gn,04.)
m dium sand to fine 0 1-. o signs of 11 drau is ai
or nondine. bystem is Ury. All vegetation—IS, 11Q1'WU-L• No repair-s needed-
CESSPOOLS:
(locate on site plan)
f C/ov�v�S
Number and configuration: '.
Depth-top of liquid to inlet invert
Depth of solids layer.
Depth of scum layer.
Dimensions of cesspool: 1
Materials of construction . 1— erg' 6?"'v-k
Indication of groundwater
inflow(cesspool must be pumped as part of inspection) ,SvSvYl /IYV.
Comments:(note condition of so;signs of hydraulic failure,level of po ,condition of vegetation,etc.)
Loam sand to medium sand to fine san lic failure or
Aon ing. System is dry. A11 vege tatl n 18 nol'mu-L- 6ytem is structur—aT17—
sound with tees in place.
PMW..
(locate on site Plan) .
Material-of construction: 1U 14 Dimensions_ ti�
Depth of solids:
Comments:(note condition of soil,signs of hydraulic failure,level of pondiag,condition of vegetation,etc.)
g )0919A T
(revised 11/03195)• g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address:
Owner.
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM: •
lack"ties to at least two permanent references landmarks or benchmarks
locate all weld within 100' '7'Qw,,V AU,4 rex do of ol.
Q
4 '
`A
• °I
DEPTH To GROUNDWATER
Depth to ,adwatei;=f..t s�method of determinatio or a tics: l I -Al,c !�
(revised 11/03/95) 9
a•nnnTn.-n rrs�-n- errra.n+n�rnr�nserrlrrnrn�•esvrr�er*e*mn nsrn-u*+a-�+renrn- .. ,�.
TOWN OF gA rn,Q+.a hl a HOARD OF HEALTH +
SUBSURFACE SF.KAGF DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
/ h«•rn«T•: -r...n-.-rnnr+n rt:++nrna+as+rnrnn:r:arsvmr�arrt+ar•rsnr.emerv-emra ra "mn•neer.m rrr._rnn.,r_r•sr-_,,+.•�
-TYPE OR PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS _486 Wianno Ave Ostervillle .Mass .
ASSESSORS MAP, BLOCK ANiD PARCEL # _ & 2 -6LZL
•
OWNER' s NAME Robert Hall
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P. Macomber Jr..
COMPANY NAME J.P.Macomber & Son INc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Street Town, or City state LIP
COMPANY TELEPHONE ( 08 ) 75 3338 FAX ( 508 ,790 - 1578
.,
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true, accurate, and
complete as of the time of�inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
• _ n : USE{==,
Check one:
XTYYY Syste6 PASSED _
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15. 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have conducted has found that .the system fails to
protect the public health and the environment in accordance with Title
5 , 310 CMR 15 , 303, and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
o .
Inspector Signature/� YA-1i't Date 2/13/96
/ One copy of this certification must be provided to the OWNER, the BUYER
(whapplicable) and thv DOARD OF HEALTH.
* If the inspection FAILED, the owner or""operator shall u d
within one year of the date of the inspection, unless allowed ortrequhe iredm otherwise as provided in 310 CHR 15 , 305 , '
s THE COMMONWEALTH OF M.A.SSA.CHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN WN THAT
Joseph P. Macomber, Jr.
Has satisfied the -Department's qualifications as re aired and"-is hereb
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A. of the
General Laws. Issued by The Department of Environmental Protection.
June 8. 1995
r '
r Acting Director of the • ion of Water Pollution Control
4
c.. OWN OF RNSTABLE
LOCATION. 6 — SEWAGE #
cl - 34
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. �� /� '
SEPTIC TANK CAPACITY j s�I A l 9 62�SS PW
LEACHING FACILITY:(type) /0/.T (size) / GOO l
NO. OF BEDROOMS fPRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER c►�(/ /
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: (/
VARIANCE GRANTED: Yes No
Qi�
TOWN OF BARNSTABLE
^LOCATION 7�b G���/1��� ✓��� SEWAGE #
VILLAGE �/ l ems' ✓. ��/�sKS SSESSOR'S MAP & LOT
p4NIS NAME&PHONE NO.
SEPTIC TANK CAPACITY ��� '
LEACHING FACILITY: (type)� �G �" /7� (size) 4
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the: l
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 leachin f dility) Feet
Funtshed-by g /�b� '
�a
EE cy
I '
I
,xe
r_y�k, yy
1
Fxs... ....3
THE COMMONWEALTH OF MASSACHUSffq.TS
BOAR® OF HEALTH \ o
TOWN OF BARNSTABLE sre�o .;-'?ez Pao
0
Appliratinn for Disposal Works Tomar inn Mit
Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Se O erDispolal
System at: die`?_.
486 Wianno Ave Osterville �i.
................_........... ................................ .... - .. ------................................................
Location-Address or Lot No.
Hall
W Owner Address
J.P.Macomber Jr.
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aa Other—T e of Building No. of persons............................ Showers
Other—Type g ---------------------------• P ( )--- Cafeteria ( )
dOther fixtures ------------------------------------------------•-----------------•--•--••--••--•---•-------••------............._.. .....-----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity..__.._.....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 ( )
0-4 Percolation Test Results Performed by.......................................................................... Date........................................
a
a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(i, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................
a ----------------------------------------•-----------------•--......--------.....-•---------.....---........................................................
0 Description of Soil...............................................................................---------------------------------------------------------------•......................
W Sand & Gravel ------------------------------•-•---_----
V ............. .----v
W
-----•---------
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
----------------------------------------------------------------------------------1=2000---gallon...pit
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 Complia ce has b n i ued y the board of ealth.
Signed : . �>s�er l��3�91
-... •--------- - ------
...------'----..Date.................
Application Approved By -------------------- ------------------------------------------ ---_--------------------- �p..�.... ..-
Application Disapproved for the following reasons- ----- ----------------------------------------------------------------..............................................................
------------------------------------------ ---------------- -- ---- ---------------------------------- ---- ---------------------------------------------------------------------- --------------- -- .................1ace --- ..........
q D
PermitNo. ........ ..f.......................... Issued ----...-------------- ----------------------------------------
Dare
No... /..:y. �.... Fxs...�... ��•.n�..
THE COMMONWEALTH OF MASSACHUSETT_�i
BOARD OF HEALTH
5-
TOWN OF BARNSTABLE
Appliration for Uhipoii al Workii Tonutrurtiun tirrmit
Application is hereby made for a Permit to Construct ( ) Ior_Repair (XX) an Individual Sewage-Disposal
System at: ' .1
486 Wianno Ave Osterville. � �i
..... .........__... ---•...-•----...............----------..........---••-.................-• ----••----...........-•-•-••--•---••••--- -•-•-•-----------.....--- .... ---•-•-•-
Location-Address or Lot No.
..Hall
Owner Address
W J.P.Macomber Jr.
a -•--•-.....----••••-•••-•--••--••-•••-•-----•-•----•-•............................................ .••---••••---------•-----••--•-•--...----....----•-•... ----....._........-•••-••-----•----.....
Installer Address
� Type of Building Size Lot............................Sq. feet
U DwellingNo. of Bedrooms.............................. .....Ex Expansion Attic
— --------- p ( ) Garbage Grinder ( )
Other—T e of Building a Other—Type g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures ---------------
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............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 ( )
a Percolation Test Results Performed by.......................................................................... Date.
-----------------------------
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Oa ...-----•------------•-------•------•---••-•-------•-----•--•---------•••••---•- -•-•••--------•• ----------•-_.
Description of Soil--------------------------------------------------------•-•-----•-•----------•----------------------------------------------------------------------•---•..........-----
v ..............•-••---------•-•----------...••---Sand--&--Grave.1..._:_=----�-----
W
x -------------------------------------------------- .............................................----------------------------------------------- .........................................................
U Nature of Repairs or Alterations—Answer when applicable..._...............................................................................:..........
--------------------------------•---------------------------------------------------.1.-1'Q D Kallon._p t
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 Complia ce has be n is ued by the board of alth.
r
Signed � '= - 10/3/91.
Application Approved B e
PP PP Y ------------- "i~ """�--------------------------------........... .......................... -- ------
j4 'Da�e-..rl�
Application Disapproved for the following reasons- ---------- ------------- --- ---- ----------------------------------------------------------------- -------------------
c . ,.
...
PermitNo. .........1 -- .......................... Issued ............................... e......
Dare -
THE COMMONWEALTH OF MASSACHUSETTS
4
BOARD OF HEALTH
TOWN OF BARNSTABLE
CIertifirate of (11poxnpliance _
THIS 1S rr0 CER�TIFY, TThat the Individual Sewage Disposal System constructed (' ) or Repaired (XX )
J P Niacornber Jr.
by .............--'------...........---------.-- .----...--------- ------------------........----- ........--------.....---- .........---........------- --- -----------...-
Installer
at ...48E.... ianno....Av e....Qs-t e_ iri.l l..e..-------------- --------------------- -- - ------------------------- -----------------
has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ..-----/ ...y ./...........- dated ----------------------------------------_----_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. / Q
DATE...................................... -/-.. ........ - Inspector ..---- ` :,_
r :
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L/ TOWN OF BARNSTABLE
I / FEE 0-09
.. ...............
Permission
J P.Maco•nber Jr.Permission is hereby granted----------'-------- -----------•-•---------.. .---•--•-•----------•----•--•----•-----------------------._....-----...._.........._-•-•-•---
to Construct ( ),or Repair (XX) an Individual Sewage Disposal System
at No... F' T�-a•?�nc�--A��P_..Q tex'vi ne.......................
Street �j �/
as shown on the application for Disposal Works Construction Permit No.__!�\�-.— Dated..........................................
-^a �--------------------- ------
DATEDATE Board of Health
----------------/•-•-... ;1--•---------...-------•---.....•...
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
I •N� •• �� 6 k k� C ra ;j u,
♦ • BLS'—. • h:: t 4 - `
d . a ,.�> •. V • p ray e� �{ -
s` �
a p f { o
9 /, •' R s
p,e
t
• + 1 �� n a, �. � .sue .� ruxt, r».
Location Map:
1 2,000±'
ASSESSORS REF.:
Map 163, Parcels 014 & 015 /
OVERLAY DISTRICT:
AP - Aquifer Protection District I \ \
Estuarine Watershed
ZONE: \ �'
RF-1 (RPOD)
Area (min.) 87,120 SF - \
Frontage (min) 20' SB/DH \
Width (min) 125' Fnd y�
Setbacks: \
Fron t 30' _ —
Side 15' °�' / Sty w S7979 45 U E IVIFRear 15' o S/o c age Fowarri � OF Borns eHo4se-_._ 1g373' �Ib
....................................
FLOOD ZONE: ! Ian
J
Zones A13(EL12), B, & C
Community Panel No. 00
#250001 0016 D �0 i 1 .___ \ 1 005
July 2, 1992 ! - _
00
V LCP 6222-B \ _ \0Qe
Lot Area 1.84f Acres \ aeJe
r (Per Assessors) \ \ Jc
,c0 84692 S.F. Approx. \
Edge Of Wetland
ro (Per Survey) Per GIS
j Estuaries 84692 S.F.
i 8 Bedrooms Allowed \ \
o 5 Main House Edge Of Lawn.
i 1 Carriage House Potential Approx. \o
M ; 0 Pool House Top Of Coastal Bank n
i rn\cr, /
j \
l Pour Cover Over
i Top of Existing Leach Pits /
-7— El. 1 4 TM s � for H-20 Loading.
! Proposed
x 14.24' \ /
I \
Driveway
Top of;pit F M`3(ei'2
l roe Sep4ie El./ 12.79 A Per BON
uilt Card.
/ 53' \ \ /
\ /
/SB � PROP T f A x Replace D-Box with
OSEDl5.s H-20 b,Box
FnK/ j COVERED rop of.To
69_27' ENTRY
FEMA Zone Lines as Shown /
On FIRM Panel # 250001 0016 Q //
, Stone ��� `� Revised July 2, 1992 \ //
jl Parking - B-ch Mark > \9F / SB/DH
I //l Area #398 sm Else., / I N Fnd
!!�o Be Removed 1() 2 Sty w/f �' o?g
x IZ07' a Dwelling chao'�
/ c
p0'J Remoe
PROP
ADD/�oEO 'a oo I x 7
PlAposed N
/ Driveway p
/ (5�P�� In x 17.04'
CC
OJ 13.24' '
m /
o
/ 1 o ' %�y 1 FEMA Zo
< /❑rage ) CJK
- /j/ •\
/Q \ E 12 'fie
Elev. _ /
/` ` A 6.48' Invert 'y
Zone_.,, i \\`,..... \ •lam oo/ 14.97'
/ -- 9 2 nonce) / P
\ h ` / / / \\........... i
/ // .`.. . SY' . OQOO"V
Vo
CO /j ) Approx Septic♦ `, X (f/tar.2A%�Ch�nce Ash 80 . �! 15.34'
Zlan e.../As—built Card `�\
20.50' ` Location of Vent to be
X ina07l hOEa. /f �` ` \ Finalized in the Field
\/S ...... � o ' GCB/D
Fnd -
111=24.6' #486
212 Sty Wlf,-
PROPOSED ;' / Dwelling
IRRIGATION
WELL
% I=24.6' - ' S#42j(2'
4 Sty w/f /
/ Tower
,cam i i
'.� rot
/
& /
Fri %
LCB
Fnd
1-601 1 /
/ate
1 A 67• SS�•c� `�`
oyJ
�A
�.i LCB
Fnd
TITLE: Site Plan PREPARED BY. PREPARED FOR: NOTES:
i
Proposed Irrigation Well Ca eSury 1.) The property line information shown was
• compiled from available record information.
g Engineering& p Bernadette T. Rehnert
At Sullivan Consulting,Inc, 2il West Bay Rd 2. e structures shown were located
Osterville MA 02655 ) The t y
d Q (506)478.3344•e0.Bax 09•7 Parker Ra-,'tbeervins,MA tYtti55
486 Wanno Road eed�wu °can•www.sWlkwwWn.com (508) 420-3994 (508) 420-3995 fax from an On the ground survey performed On
or between 04/NOV/13 and 07/NOV/13.
copesurv@copecod.net
3.) Spot Grades are from an on the ground survey O
Bamstable, (Osterville) Mass. using bench mark provided by cape surv.
Draft: JOD Field: WHK/MDJ 30 0 15 30 60 120
DATE: SCALE: rr_�Or Review: PS Comp.: WHK/RRL
February Jr, 2019 1
Project: 33038 Proiect: C800_2