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0111 MOUNTAIN ASH ROAD - Health
175 WOODSIDE RD., MARSTONS MILLS. A= 124 030 IPA I.� _ � � : lh� �� 7 - add �, ��� �� ,� �, 175 WOODSIDE RD., MARSTONS MILLS A = 124 030 i i I i i o ' UPC 12934 ' o - ,�► ""Asi MA0,MN �� p �t7 .mil 19(,�' �.cP ��r�►�`� i'�jl��`''''e ���P lh aid ? vo 'I 4; h 1 TOWN OF BARNSTABLE Y LOCATION ��� rev 1?,5ocf SEWAGE # VILLAGE fYlQr�0/95 ILLS ASSESSOR'S MAP & LOT ,00 INSTALLER'S NAME&PHONE NO. 706 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) e (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by UkcKean, Thomas From: McKean, Thomas Sent: Tuesday, November 27, 2007 8:05 AM To: Dillen, Elizabeth Subject: RE: Accessory Apartment- 175 Woodside Road, West Barnstable The confusion in this case is mostly due to the 1998 septic system inspection report by John Graci which shows only one septic system. A septic system if that size could only handle three or four bedrooms. That inspector failed to locate a second septic system on the property at that time. A percolation test would be needed if someone determined a new septic system needs to be designed and constructed. At this time, I don't know if th igais necessary. If there is a second septic system somewhere on this property, the ownerire someone to attempt to locate it before scheduling a percolation test. That would be my recommendation. -----Original Message----- From: McKean, Thomas - Sent: Tuesday, November 27, 2007 7:57 AM To: Dillen, Elizabeth Subject : RE: Accessory Apartment - 175 Woodside Road, West Barnstable Hello Beth, I reviewed the file at the Office this morning. I suggest that she should hire a septic system inspector to determine where the second septic system is located and to determine it's capacity. If there is a second septic system, there should be sufficient capacity in the two systems for the requested number of bedrooms. If there isn't a second septic system there, the next step would be to schedule a percola7ion test to design a new system. -----Original Message----- From: Dillen, Elizabeth Sent: Monday, November 26, 2007 10:00 PM To: McKean, Thomas Subject: RE: Accessory Apartment - 175 Woodside Road, West Barnstable she scheduled a perc test because she was told she needed a septic upgrade. I will fax over a new application on Tuesday -----Original Message----- From: McKean, Thomas Sent: Mon 11/26/2007 8:36 PM To: Dillen, Elizabeth Subject: -Re: Accessory Apartment - 175 Woodside Road, West Barnstable I am not at the Office tonight. But my recollection is that the applicant needs to file a new application for six bedrooms. Seven cannot be approved. I cannot recall whether or not this parcel is located in a nitrogen sensitive area (GP or WP) - is it? Are there private wells in this area? What is the size of the lot? Why was a perc test scheduled? I did not recommend a perc test. -----Original Message----- From: Dillen, Elizabeth <Elizabeth.Dillen@town.barnstable.ma.us> To: McKean, Thomas <Thomas.McKean@town.barnstable.ma.us> CC: Taylor, Madeline <Madeline.Taylor@town.barnstable.ma.us>; Buntich, Jo Anne <joann.buntich@town.barnstable.ma.us> 1 ��5 Sent: Mon Nov 26 16:09: 10 2007 Subject: FW: Accessory Apartment - 175 Woodside Road, West Barnstable Hi Tom - Hope you had a great Thanksgiving! I am helping Jo Anne Buntich with some of the pending accessory apartment cases, and noticed a note in Maddie's file saying that you would approve 6 bedrooms at Deirdre Kyle's property. If this is the case, she will not proceed with the perc test she has scheduled for tomorrow (see her message below) . Please advise. Thanks, Beth Beth Dillen Special. Projects Coordinator Growth Management Department Town of Barnstable 367 Main Street, Hyannis MA Tel 508.862.4683 Fax 508.862.4782 -----Original Message----- From: Deirdre Kyle [mailto:dkyle.hollylegal@verizon.net] Sent: Monday, November 26, 2007 3:57 PM To: Dillen, Elizabeth Subject: RE: Accessory Apartment - 175 Woodside Road, West Barnstable Hi Beth: Just following up on our telephone conversation this morning. I have a perc test scheduled for tomorrow morning, and I would really like to know what is going on. The entire reason for the 9 month delay is because the Board of Health was saying that my septic system was only for a 3 bedroom house. If Tom McKean has approved the application for a total of 6 bedrooms, then why wasn't I notified of that? It is not my intent to upgrade to 7 bedrooms - the 7th room is an office with no closet. This Pandora's box was opened based on the Board of Health's file (or lack thereof) , and now I'm totally confused (again) ! ! Please advise ASAP. Thank you, Deirdre P.S. As you are no longer the coordinator for the Accessory Apartment Program, kindly advise who I should be dealing with from now on. Thanks! -----Original Message----- From: Dillen, Elizabeth [mailto:Elizabeth.Dillen@town.barnstable.ma.us] Sent: Wednesday, November 21, 2007 10:56 AM To: Deirdre Kyle Subject: RE: Accessory Apartment - 175 Woodside Road, West Barnstable Deirdre - I am no longer the coordinator for the Accessory Apartment Program, but when I received this email I was able to check your file and saw that the Health Division Director Tom McKean had authorized an approval of your application for a total of six bedrooms at the property. Are you moving forward with the septic upgrade to allow for seven? I just want to make sure you don't spend the money on an upgrade if you don't need 2 to. I notice on your floor plans you have six bedrooms and an office - if you simply widen tie doorway to the office to five feet, you would be in compliance. ' If you wish to go forward with the upgrade, let me know, and I will have you fill out a reimbursement contract and W-9 before the work is done so you will be eligible for $5, 000 in reimbursement. Beth Dillen Special Projects Coordinator Growth Management Department Town of Barnstable 367 Main Street, Hyannis MA Tel 508.862.4683 Fax 508 .862.4782 -----Origina_ Message----- From: Deirdre Kyle [mailto:dkyle.hollylegal@verizon.net] Sent: Tuesday, November 20, 2007 2: 40 PM To: Dillen, Elizabeth Subject: Accessory Apartment - 175 Woodside Road, West Barnstable Hi Beth: I've finally arranged for a new septic system. Perc test is scheduled for 11/27/07. Down Cape Engineering is working on the system design. It is my understanding that everything will be done in a few weeks. Please advise as to what the next step is, and the expected timeframe. Thank you, Deirdre Kyle -----Original Message----- From: Dillen, Elizabeth [mailto:Elizabeth.Dillen@town.barnstable.ma.us] Sent: Thursday, April 05, 2007 9:03 AM To: Deirdre Kyle Cc: McLaughlin, Charles Subject: update Hi Deirdre - I'm just checking in to see whether the septic engineering report has been completed? Beth Dillen, Special Projects Coordinator Growth Management Department Town of Barnstable 367 Main Street, Hyannis MA Tel 508.862. 4683 3 � 2"7 Town of Barnstable Health Inspector �tHe iq�, Office Hours . o Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 = HARNSTA13M « MASS, Public Health Division 1639.ArEpMO''tA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 50&790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: -� p Address: Ma Parcel /� Name: Phone#:� 9y401 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? �U If yes, how many? 2c. How many bedrooms total'are proposed at this property (including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home.plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ONO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 7V 5. Is the dwelling connected to an ONSITE WELL or to P=WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. ' 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? vES or,3 NO I 9. Has the septic system been inspected by a DEP certified inspector within the last two years?- rYES ©r NO I "A S� 4 FOR OFFICE USE ONLY r' POy Public Health Division has no objection to be rooms at thisproperty. Sl �ro � � J pecial Co ditions: G G - S 'vti5u c;4 -'Se-A r,i Signed: Date: 2 Q;/health/wpfzles/amnestyap 7 K j- - i JJ I , jr- ' - I. l I ZV : 4 SG .. .. I y.:.. I � 2= -? .I _ r 0 �i I I- . ',s : sa _ •� l I ..I- --:..i: .. --; IT-- � ramI i ii I .�1 r,I. .. .. -- j.lII. !I iI I _r _ ..�.. 771 L_on 4 . 77 4 12 i FROM WALTER KYLE PHONE NO. 508 428 1115 Jan. 22 2007 06:02PM P2 ........ V�V- , , • I 1.AlT C� j.... - N : 1 I .i , : I � , T I ! A^ 77, j i : I II /+- r n Cl✓ - / I i 47I - • 1 i I + �� ', j I i ' j I j � I I •I IA---- I i ; ! i j ZJ 4_4 i I .... ) 1 I ' I I - ��YJJY,•. Y_'_"_""'1(•-=Y4 .•A.e/?fj/-R•-� ..: , I ------ ; I , I i I - - - ; f�4 , x. �L. I 11 0 i I ,1 i I I 1 I . i. r_. 1 , T C I fit 4-4 IL II , m , 1 �t , I - _ N - - - - - - T I 1 I 1 I I - - c i I � ...I i _... I , I I • I , I I i 1 I I I t. : i. , r I I I co I 1-- } C . i i_. , Y I I I r T....:.....: i I� 1 i J. i : LLJ LL A. : 1. r I 1 � T ! r� 11I _ - - _ 0 �--,--�- -- --, ---r , , t , ; , I :i , r— - FROM WALTER KYLE PHONE NO. 508 428 1115 Jan. 22 2007 06:02PM P3 i : r i I , i r i II — _ _.. _..._1--.. .........i..... 1 .4 ._ i I tit I i i I I i I f , i i r --- 01. i ,2 '� i i , { , i i I •' i I o I _I 7 I � I I I ' ; I i !: ..i. oo— i �- E 1 f ZHE r OF �fy ti The Town of Barnstable * BABNSfABLE, + MAC. A Growth Management Department �? �� tED i63�fAO�A 367 Main Street, 3rd Floor Hyannis, MA 02601 Tel:508-862-4678 Fax:508-862-4782 January 16, 2007 John C. Klimm,Town Manager Janet Joakim, Town Council President Barnstable Town Hall 367 Main Street Hyannis,MA 02601 Re: Deirdre Kvie- 175 Woodside Road,West Barnstable,MA- a single-family accessory unit This letter is to inform you that the Accessory Affordable Apartment (Amnesty) Program has received a request for a project eligibility letter under the Community Development Block Grant (CDBG) Fund and under Article II of Chapter Nine of the Code of the Town of Barnstable and the criteria for the Local Chapter 40B Program. This office is reviewing the request. If the Town has any comments on the project, please forward viem to me so that they can be addressed in the site approval letter. This letter gives you official notice of our receipt of the above application(s). We will issue a decision as to the acceptability of the sites and the consistency of this development within the guidelines of CDBG. incerely, abeth Dillen pecial Projects Coordinator rowth Management Department cc: Legal Department Building Department Public Health Department -� COASTAL KITCHEN CABINETS 5085545197 P_9x Cortullonwcaldl o massat huscus Eaecutz��e Off oc ofEnviromuental AQairs Dept. of Environmental Protection One wifttcr Street T'lostmi,Md.02108 John Gruel 1.).P".P.'title V HerAiw Inspector P_().Box2119 'reaticket,MA 02536 WILLIAM F.WELP (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.G"nwr SUBSURFACE SEWAGE D13POSAL SYSTEM INSPECTION FORM PART A CEIKTiFICATIO N ,�,na,pta-i - a?� prepo►ty Address: 175 Mraod.ide Rd.Marstoae Mills Address of Owner. Date Of Inspection' 31WN (if different) Name of Inspector: John Gnttni Shwky Ingraham'IT$Woodside Rd,wirst Samstable02868 i am a OEF approved system inspector pursuant to Section 16,340 of Tide%(3t o CMR 15-009) . Company Name,Address and Telephone Number, st?RTI>1t'A ION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the informetion reported below Is true,accurate and Complete as of the time of Inspection. The inspection was performed pasta on my trslnlnp and experience in(he Ix'oper fUnction and rnatntanance of on-site sewage disposal systems. The system: x Passes 7hlalnepecHnnbMaadenuft•dAd•ltnreaeTtl.V ConGltidnallyPa sea 'o°e4tRAwMe�n,,b? tIntoo eanvwortatandos peAmrmNp R Ne tine m Ale ieKtrtE4en,My tnaptnten seat Needs Furl r valuation By the local Approving Authority Ql"?VM andantyorauaralaeeOfth.rongevtyora e Falls emertm eomponenb uaRatKa. inspector's signature; Date: 3ftt1/96 The System Inspector shall submit a Copy of this inspection report to the Approving Authority within thirty(30)days of complatin0 th;c inSoett 0n5. if the system is a shared system or has a design flow of 10.000 god or greater,the inspector and the system owner shalt submit the report to the appropriate regional office of the Oepertment of Environmental Protection. The original should be sent to the system owner and coeles sent to the buyer.if applicable and the approving authority. INSPECTION SUMMARY; Ohack A,6,C,or Cl: i A] SYSTEM PASSES: 9� 7 S x I have not found env information which indicates that the system violates any of the f4lWre criteria deilned as in 310 CMR 15.303, Any failure Criteria not evaluated are indicated below. C� � comMNTS; BI SYSTEM CONDITIONAI.LY PAS$E5: er � One or more system components need to be replaced or repaired. The system,upon completion t <r c9Z9 �of the replacement or repair,passes Inspection. ` � J indicate yes•no.or riot aetermined(Y.N,or NO). Describe basis of determinatior.In ail instances, If "not determined',a pain why;not The septlC tank is metal,unless the owner or operator has provided the system InSpeci0r WRh a copy of a Gettifi Ate 0f_.yam+ '. C6hlpllance(attached)indicating that the tank vras installed within twenty(20)years prior to the date of rho Inspection,or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration of ex(iltration,or tank failure Is imminent.The system will pass inspection R the exis6nq septle tank is replaced with a conforming septic tank as approved by the Board of Health. (revised atrt7A7) Ona Winter Street • Boston.Massachusetts 02108 • FAX(617)556-1049 P Telephone(617)292-5500 Td WdLS:OT 866T W 'hpW ST86 SPS TK 'ON 3NOHd 3_1AA 'S d31-W WOdj CORSTAL KITCHEN CABINETS 5085645137 P.02 3VesUR1'ACF SEWAGE DISPOSAL SYSTEM INIFECTION FORM ART 8 CHECUST Property Address. 175fYoodsldefthlarstonsMies owner r4ncfteytnylahafn:f7S Woodside Rd.West ear labl4ce2eeg Data of Inspection:319198 Check if the following have been done:You must indicate eltner"Yea'•or"No"33 to each of the following: _ Pumping information was requested of the owner,occupant,and board of Health. z None of the sYsfem components have been pumped for at least two weekc and'he and the systern has been receiving normsf flow rates during that oertod. Large volumes of water have not teen Introduced Into the system recently or as part of this Inspection, —ri As built Plans have been obtained and eXamined. Note if they are not available with NIA. The facility or dwelling was Inspected for signe of sewage back-up. r _ The system does not recelvo non-sanitary or industrial waste flow, -x-- The site was insnfscted for signs of breakout. x All system Components,excluding the Soil Absorption system,have tort located on the alte. x The septic tank manholes were uncovered.opened,and the interior of the 9epfic tank was ir1speeted -- for condition of barrios or tees,material of construction,dimensions,depth of iigttld,depth of uludge,depth Of scum. a The size and location of the Soil Abserption System on the site has been determined based on The facAlty owner(and occupants,ff different from owner)were provided with information on the proper Mairtananee of x sub-Surface 01Spos31 Systens. M J Existina Information,Ex.Plan at 6.0,H, Determined in the Field(d any failure Criteria related to Part C is of fdsue,approximation of d istance is unacceptable)(15,302(3)(b)( c:or..aornrmi Ed WUBS:OT 866T W 'FpW ST86 SPS T82- 'ON BNOHd 31AM 'S d31-lUM WOdJ �I COASTAL KITCHEN CABINETS 50S5645237 P.06 6tJ95URFgCE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMAVON Property Address: '1rSWoo4Iswe7td.M8r1ton!;tM1s Owner: BhelYy M"ap=1,r%Waoe9de Rd West barnv&W CZ968 Data of lnspactton:315198 FLOW CONDIMNS Design flow: 6M, ^ 9.p.d.loqd`oom for S.A.S. hltatlber of bedrooms t41j1?1bW of current residents:_„ Garbage grinder(yes or no): y_ laundry connected to system(yes or no): vas Seasonal use(yeS or no):Ns le-(taut two(2)year usage(ypd): water meter readings.It SVRllab we Sump Pump(Yes or no): n_ 1851 date of occupancy:ms co!AM ERCIAUJUQUSTR W 6- Type of establishment:tltt E)esign flow:6 gaII0rWdaY Grease(rap present:(yes or n0).io— Industrial Wasta holding Tank present:(yes or no) No Non.eanitary waste dischptged to the Title 5 system;(yes or no)n< water meter readings,if avallable: Re F_oct date oT occupancy: w• OT14 ER:(Describe) ^m Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: mvnw edl5i*r*s . tr Sl9terh pumped as part of Inspection;(yes or no)_�(2 9 If Yes.volume ptanved:-t2c 9ellons3 Reason for pumping.,, z�LSI— TYPE OF SYSTEM x septic Mdnkldlstributlon boXrsol)absorpt ons system Single cesspool — — overflow cesspool Privy Shared system(yes or no) (ifyes,attach previous inspection records,if any) UA Tachnofogy etc.Copy of up to date contract? Other: APPROXIMATE AG9 of all components,date Installed(If known)and source Information: ley) Sewage odors detected when arriving at the Slte:(yes or no) No (reylaed0=fn 2d WUGS:OT 866T 0Z 'FeW ST86 SbS T82- : 'ON 3NOHd 31AA 'S d31-IUM : WOdJ COASTAL KITCHEN CABINET$ 5085645157 P.04 SUBSURFACE SEWAGE 013POSAL SYSTEM TNSPECT10N FORM PART C SYSTEM INFORMATION(contiaNed) Property Address: ITa Wo46140 Rd.Marston IFI Na OWttar, StlerteyR►gaff,arn:176W4odstoeR0.West8arrlstadleu2EE8 Date of inspeellon:1FAg SEPTIC TANK: x (locate on site plan) Depth below grade:0^ twaterial of construction:x cone—ate metal FRP Polyethylene_other(explain) If tank is metal,list ege__.is age confirmeTby ce-ft'icate of Compilance Nc (YeVNo) Dimensions:l fr Mflr.we,Cr Sludge depth:3` -- OlStence irOln 100 Of SIU400 to Dottoin of outlet tee or baffle:zd" Scum thickness:0 VIStence from top of scum to top of outlet tea or baffle:6- Distance form bottom of scum to bottom of outlet tee or baffle:a Now dimensions were determineo: mcgw<a Comments: (recommendetion•for pumping,condition of Inlet and cut et tees or baffles;depth of bquld level in relation to outlet invert,structural Integrity, evidence of,leakage,etc.) 8•pUctarMtadrdlcvmoenetNa�taOcttaslri•pmOantlNngoing&01■rb.Vfi&AfmuctONneaw<0UPtoayet"PACdlnlm.rdpwwol Njv � t1.7p11QC!'i GREASE TRAP:— (locate an site clam) Depth below grade;r Materietatcortstruction: _tenerate,�,<metal,�FRP_Pofyeihyiene_,,,,,,othat(vxpiainj Dimensions:we Scum tt ickneso "t• Dstance from top of scum to top of outlet fee or baffle:nfa Distance from bottom of scum to bottom of outlet tee or baffle;rjs Date of last purnptng'. Comments: (recommendatign for pumping,condition of Intel and outlet teas or baffles.depth of liquid level In relation to outlet invert,siuotural inteerity. Ovidenae of leakage,etc,) to BUILDING SEWER: (Locate on Otte plan) Depth,below grade;IV Materiel of constructian:._._cast Iron,,,_,_40 PVC other(explain) Distance from private water supply well or suction line" Diameter,_d-_ Cvvmmentw(condttlons of)olnis,venting,evidence of leakage,etc.) lnvlad�.rp'mn bd WU6S:OT 866T OZ 'FpW ST86 SVS Ta ON 3NOHd 3_1AA 'S 63i-1Uhl WOdj COASTAL KYTCHEN CABINETS Z085645137 P.OS SUBSUF(FACE SEWAUE DISPORT CsYs7EM INSPECTION FORK{ SYSTEM INFORMATION(continued) property Address, t�SWooAsideRd.rflarstonaNi�na Owner: eHaley Mgranw;17S Woodswe Rd.Weal BwYNIabie Meg Date of I11spectlon:9)'JJC8 SOIL ABSORP71ON SYSTEM(SAS):x (loe8te on site plan,if possible',ex03vattlon not required,but may be approxhnated by Ron-inttUsive methods) If not determined to be proyent,explain: �R Type: leaching pits,number:one::po0016"teeehpa. leaching chambers,number:M leaching galleries,number:N_,?__ leaching trenches,number,length: roa_ Iaachfng fields,number,dimensions NA overflow cesspool,number:du Alternate Name(A Technology; ,o• syet Comments:(note condition or Soil.signs of hydraulic tailure,level of ponding,condition of vegetation,etc.) Leads da nwi tli eomponarn Rn aMUffs Yaund am!ftmdWIM OTE"1 r hKe it a.nneyr efwdar In tL CESSPOOLS, _ (locate on site plan) Number and configuration: ..... Depwtep at f quid to Into invert:*a Depth of solids layer: "i8 Depth of scum IsS+er "ta �- Dimemions of cesspool: hft Materials of construction: n4 Indleaiion of groundwater_ nh inflow(Cesspool must be pumped as pan or inspection) rat Comments:(note Condition of soil,signs or hydraulic failure,level of pending,condition of veoetation,etc,) da PRIVY:— (locate on site Dian) Materials of construction; Dimensions: ^i ,_ Depth of solids', NA Comments:(note condition of soil,signs of hydraulio failure,level of pending,condilion of vegetation,etc.) Ni (npYMea Wflrlbn Sd Wd6S:0i 866T OZ 'fipW ST86 SPS Ta ON 3NOHd 3-1AA 'S d3i- i(n W0dj SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 175 Waodllde Rd.Maratons!+lifts aerleyfngrahw.'ITS Woodside Rd.Welt oemstaoce oZOU 318198 SKETCH OF SE=WAOF DISPOSAL SYSTEM: incWe ties to at least tvw permanent references,landmarks or benchmarks locate all wells within 100'(Locate where public water supply Comes into house) �A Q e i 3fi (rlvh.ee.?rR7] 0.0, f of Ia 9d Wd00:TT 866T W -FleW ST86 SPS TOL ON 3NOHd 3-VA 'S d310UM W0dj Colimionwealth of Massachusetts Executive Office of Enviroraiiental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 John Grad ' D.E.P. Title V Septic hispector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MW a-i �- -1 6 Property Address: 175 Woodside Rd.Marstons Mills Address of Owner: rp1 Date of Inspection: 315198 (If different) yNOFe 1990 Name of Inspector: John Graci Sherley Ingraham:175 Woodside Rd.West Bam¢table 0266�� I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) �f , Company Name,Address and Telephone Number: ', 10 f 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: X Passes This Inspection Is based on criteria donned In Title V Conditional) Passes code 310CMR16.303.My findings are of how the system is Y performing atthe time of the inspection.My Inspection does _ Needs Furt r valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Fails septic system and any of Its components useful lire. Inspector's Signature: Date: 3110198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 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: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is 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 conforming septic tank as approved by the Board of Health. (revised 04J27)97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 175 Woodside Rd.Marstons Mills Owner: Sherley Ingraham:175 Woodside Rd.West Barnstable 02668 Date of Inspection:315199 _ Sewage backup or.breakout.or hiah.static water level observed.in.the distribution b.ox is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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: Conditions exist which require further 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: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 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 of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: 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. Yes No _ — Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or ponding of effluent to lha Surface of the ground or surface waters flue to an overloaded of clogged cesspool. — SAS is in hydraulic failure. (revised 04127)97) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 175 Woodside Rd.Marstons Mills Owner: Shertey Ingraham:175 Woodside Rd.West Barnstable 02068 Date of Inspection:315rs8 D] SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. 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 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. 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. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: 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: 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) 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 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revleed 0427187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 175 Woodside Rd.Marstons Mills Owner: Sherley Ingraham:175 Woodside Rd.West Barnstable 02068 Date of Inspection:315198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. — x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. V — The site was inspected for signs of breakout. x — All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected — — for condition of baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x — The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)] (revised 0427)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 175 Woodside Rd.Marstons Mills Owner: Shertey Ingraham:175 Woodside Rd.West Barnstable 02068 Date of Inspection:3151911 FLOW CONDITIONS RESIDENTIAL: Design flow: sm g•p•d./bedroom for S.A.S. Number of bedrooms: 6 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n/a Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nra Last date of occupancy: nra OTHER:(Describe) Ma Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was pumped 15 years ago. System pumped as part of inspection: (yes or no)=tA2S If yes,volume pumped: . 0-t�gallons Reason for pumping: cun\ N; e\C3-- TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: 1973 Sewage odors detected when arriving at the site:(yes or no) No (reylsed 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 175 Woodside Rd.Marstons Mills Owner: Shedey Ingraham:175 Woodside Rd.West Barnstable 02888 Date of inspection:315199 SEPTIC TANK: x (locate on site plan) Depth below grade: e" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: 1.e1^He7"w410" Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness:o Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound and functioning properly.Washer must get hooked up to system.Recommend pumping'toe '�j Y C,(S GREASE TRAP: (locate on site plan) Depth below grade: nia Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: nia Scum thickness:nia Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: ma Date of last pumping, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) rya BUILDING SEWER: (Locate on site plan) Depth below grade: 14• Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction lineto- Diameter: 4" Fieimments: (conditions of joints,venting,evidence of leakage, etc.) (revleed 04R7)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 175 Woodside Rd.Marstons Mills Owner: 8herley Ingraham:175 Woodside Rd.West Bamstable 02668 Date of'Inspection:315198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rrla Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: n1a Capacity: nN gallons Design flow: Na gallons/day Alarm level:_nla Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) We DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: aia Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) nfa PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 0WD97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 175 Woodside Rd.Marstons Mills Owner: Sherley Ingraham:175 Woodside Rd.West Barnstable 02668 Date of Inspection:315198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits,number: one:tpgo gallon leach pit leaching chambers,number:rva leaching galleries,number: nla leaching trenches,number,length: Na leaching fields,number, dimensions:nla overflow cesspool,number:Na Alternate system: nra Name of Technology:_rva Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach pit and all components are structurally sound and llmctioning properly.There la currently 2'orwater In it. CESSPOOLS: (locate on site plan) Number aind configuration: Na Depth-top of liquid to inlet invert: nla Depth of solids layer: Na Depth of scum layer: rda Dimensions of cesspool: nla Materials of construction: nla Indication of groundwater: rya inflow(cesspool must be pumped as part of inspection) Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: NO Depth of solids: Na Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) We (revisedOd111)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 115 Woodside Rd.Marstons Mills Sherley Ingraham:175 Woodside Rd.West Barnstable 02668 315198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) I t►c La Q d� g 33� A DA 7� Rg 43 b � 3ti (nv1sed04WJ9T) Page ! of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued 175 Woodside Rd.Marstons Mills Sherley Ingraham:175 Woodside Rd.West Barnstable 02668 315/98 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts. (revised0027197) page 10 oI 10 Comionwrealth of Massachusetts Executive Of-lice of Environmenial Affairs Dept. of Environmental Protectim Onc wintar Strcct Boston,Ms. 02108 .TAhri tf ' I).�.P, Title V Septic Inspector P.().k3ax 2119 'Teaticket,MA(]2�3G WILLIAb1 F.WELD (508)564-6813 Govwnoe ARGEO PAt1L CELLUCCI Lt Governor SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FARM PART A CERTIFICATION Prope.Ay Address: 475 WoodWde Rd.Marston MGlls Address of Owner: Date of Inspection: 315198 (it different) Name of Inspector: John Graci sherlay Ingraham.175 Woo4side Rd.West Ramerable 02668 I am n OEP approved system inspector purauont to Section 15 340 of Titla%(310 CMR 1s 000) Company Name,Address and Telephone Number; CERTIFICATION STATEMENT I certify that I have personally inspected the seveage disposal system at this address and that the information reported below is true,uccura'ta and complete as of the time of inspection, The inspectton was performed based on my training and experience in the proper function and inaintenance of on-site sewa)c disposal systems. The system: X Passes TNr lnsgoetlot Is bps4dartCfitafleG�QnadlnnleY ConditmnallyPa ses coda"rig=Ti.ilm.My8nClnnsaroorgeytt+aAt/aemia• p►rronttinp atria tLee 4r Ino irtspoalon,t+ty InspashOndoes _ Needs Furth r valuation By the Local Approving Authority notlmpyanywunnw mIIuarontan arm.tonowM ar Me Fails spp ie¢Y+itrftn end eriY Qrits eempanentt uramlll$ Inspector's Signature: Data: 3111188 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspsctlons, It the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and ire system owner shalf autimit me 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: Checic A,B, C,or D. A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure Criteria defined as in 310 CMR 15.303. Any falkire criteria not evaluated are Indicated below. COMMENTS: S] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes,no, or not determined(Y. N,or NO). Describe basis or determination in all instances. If "not determined",explain why no; Tne septic tanK is metal,unless the owner or operator has provided the system inspector with a copy of a CeRdicate CT CdMpllance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspector;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or eXtiltratlOn,or tank failure is Imminent.The system will pass Inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (rvVL1cdtu177e7) Ono Wimor Street - Boston,Massachusons 02109 tr FAX(G17)55G-10A3 • Tialephpoe(fill)292.5500 l8l 'ON Wd00 : l l LOOZ 'S '83d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 775 Woodside Ra.Mamtons Mills Owner: Sherley Inarohzcm:f75Woadsidc Rd.West 6amsrable Q2568 Date of Inspectlon:34198 Stwaae backuo or,breakout or high static water level o5served,rn.thc distribution box iis due zo a broke(+, or obstructed pipe(s)or due to broken,settled or uneven distribution box The system wilt pass inspection If (with approval of the Board of Health). Describe observations; broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced Tine system required pumping more than four tirnos a year due to broken or obstructed plpe(s). The system will pass inspection if(with approval of the Board of Health); brokcn pipe(s)are replaced obstruction i3 removed CI FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation DY the Board of Heath in order to deteruine if the system is failing to protect ilia public health.safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM dS 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 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPR(ATE)DIET F-AMINE$ 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 of water supply or tributary to a surface water supply The system has a septic tanit and soil absorption system and is wiUt ri a Tone 1 of a pl rbllc watersupply we11, The system has b sutptic tank and soil aosorption system and is within 50 feet of a private watersupply Well. The system has a septic(ank and soil absorption system and the SAS Is less than 100 feet but 50 feat or more from a private water supply well,uniess a well water analysts for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presernse of ammonia ntrogen and nib-ate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indleate either"yes"or"No"as to each of the following: 1 have determined that the system violates one or more of the following failure criteria as defined in 314 CMR 15.303. The basis for this oeterminauon is identified below, The Board of Health should be contacted to determine what will be necessary to correct the failure. YeS No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of erfluent to the surface of the ground or suriaee waters due io an overloaded or clogged cesspool. SAS Is in hydraulic failure. IrevlseC W2T9t;) ti d 181 'ON W 0 : 1 1 LOH 'S '83] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 775 w000sioo Rd.IYtarstuns Hulls Owner. Sherleyingraham;175 Woo dsidc R0.West aamomble 02668 Date of Inspection:315198 0]SYSTEM FAILS(continued) Yes No Static liquid level.n the distribution box above outlet invert due to an overloaded or clogged SAS or cesspoal. Liquid depth in cesspool is less than 6"below invert or available volume is less than 12 day flow, Required pumping more than 4 times in the last year NOT due 10 clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy Is within 100 feet of a stlrrace water supply or tributary to a surfice 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 or a cesspool or privy is lass 10an 100 feet but greater than 50 feEl from a private water supply wen with,na 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. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as 10 each of the following. The following critena apply;o large systems in addition to the criteria: T The system serves a facility With a design flow of 10.000 gpd or greater(Large System)ano the systeth is a significant threat to public health and safety and the environment becaust;one or more of the following conditions exist. 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) The owner or operator of any such system shall Dring the system and facility Into full compliance with the groundwater treapneni prbgram requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (rons�A dd27Je7} S d IS[ 'ON AM : [ [ LOE 'S '833 SU"URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CH ECLIST PTO perty Address: 1751Ndddside Rd,MarstOnS Mus Owner- Shertey ingrobam>175 WOOd5ldo Rd.WeHaamstabte o2doo Date of Inspection:315/99 r Check if the following have been done:You must indicate either"Yes"or"Ne as to each of the following: _x_ — PUMPIng information was requested of the owner,occupant,and Board of Health. x None of the system componenis have been pumped for at lei3st two weelcs and the and the System has been receiving normal flow rates during tnat period. Large volumes of water have not been Introduced Into the system recently or as Dart of this inspection x As built plans have been obtained and examined, Note if they are not available with N/A. x _ The facility or dwelling was inspected for signs of sewage back-Up. x The systan does not receive non-sanitary or:ndusirial waste flow �— — The site was inspected for signs of breakout x _ All system components.excluding the Soil Absorption System,have been located on the site. x .The septic tank manholes were uncovered,opened,and the Interior of the septic tank was inspected — for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site nas been determined based on The facility owner(and occupants, if different from owner)were provided with informatidn on the proper mfltntenance of Sub-Surface Disposal Systens, x F_xitting information. Ex. Plan at 5 O.H. x Determined In the field(if any failure criteria related to Part C is at issue,approxrmation of distance is unacceptaDle)(15.302(3)(b)) Gorr:"a oa2T19it , 9 d 181 'ON AV10 : l l 10H 'S 833 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1751Noe dr,I d e qd.Marston N1198 Owner: Sherley Ingraham;775 Woodside Rd.WestBamstable 02063 Data of Inspection:9/5199 FLOW CONDITIONS R ESI DENT I�!~ t Design flow, s3o 9•P d,lbadrootn for S.A.S Number of bedrooms: 6 Number of current residents: z Garbage grinder(yes or no): No Laundry connected to system(yes or no); ra: Seasonal use(yes or no): No water meter readings,if avallaDle.(lasr two(2)year usage(god): Sump Pump(yes or no). tip Last care of occupancy.rda COMMERCIAL/I N DUST R IAL' Type of establishment: nfa Design flow:0 tlallons/day Grease trap present:(yes or no) Nam_ Industrial Waste Holding Tank present;(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available WO Last date of occupancy: rite OTHER:(Describe) rib — a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 8yrtem ww pumped 16 years apa. System Dumped as part of inspection:(yes or no)_�� If yes,volume pumped. . t)�nallons Reason for pumping: rA�NZ '- nt-y-- TYPE Of SYSTEM x Septic tanktaistributlon boxisoil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (If yes,attach prev)ous inspection records,if any) VA Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(it known)aria source information; 1977 Sewage odors detected when arriving at the site.(yes or no) No rtevlsed=27h7i L 'd 181 'ON M10 : l l LOOZ 'S '83d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1751400dsideftmarstonsMil)z Owner: Sherley Ingragam;175 Woodside Rd.Wcst Bamstablc G2C6a Date of Inspection:X 198 SEPTIC TANK: x (locate on site plan) ' Depth below grade:e" material of construction;x concreate metal FRP Polyethylena_othef(explain) If tank is metal,list age pr. .Is age eonflrmeCby Certificate of Compliance Na (Yesft) DimenSlonS:LwxS,r W4yo^ Sludge depth:"' Distance from top of sludge to bottom of outlet tee or Daffle.24" Scum thickness;0 Distance from top of scum to top of outlet tee or baffle:e" Distance form bottom of scum to bottom of outlet tee or baft1e'o How dimensions were determired. mc5surcd Comments- (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence;of Leakage, etc.) sopeerankandaucomoononts are.uucnmO eoundandrunNonin6pmparg,washer murtpattiee4adwPto.rotemAeeommend i;umolna,e,:j SA—ND( ?Cr5- y GREASE TRAP:` (locate on site plan) Depth below grade: rd.d4 Material of construction: concrete metal FRP Polyethylene—other(explaln) Dimensions: roe Scum thickness:roe Distance from top of scum to top of outlet tee or Dal W nra Distance from bottom of scum to DCttom of outlet tee or baffle:iva Date of last pumping-,,. Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) N� BUILDING SEWFR: (LOCSte on site plan) Depth below grade:_i,- Material of construction:_cast iron�40 PVC_other(explain) Distance from prrvate water supply well or suction linvow" Diameter: 4- Q,imments:(condilJons ofjoints,venting,evidence of leakage,etc.) tradsod o+mis7) a d 181 'ON 010 : 1 < LOOZ ,S 'ald SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 175 Woodside Rd.Marstons Mills Sherley Ingraham:175 Woodside Rd.West Barnstable 02668 315198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) A ( ac �R Q �e g 33 ' 4 gg 4�b (revwd0dr17197) Page ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contlnued) Property Address: f�SwooGsiooRo.r+tarseonsMltl• Ownor Sberley rnoranam:175 Woodside Rd.Wcst l5arrrstao1c 02068 Date of Inspection:315198 t TIGHT OK HOLDING TANK: (locate on site plan) Depth below grade:Na Material of constn,tctton:_concrete—matel_PRP_Polyethylene_other(explain) Olmensi ons: Na . capacity:^n1a _ gallons Design flout: nfa gallons/day Alarm level:_iv` Alarm In Awking order?_,Yes_No Date of previous pumping: Comments: (condition of inicl tee,conditlon of alarm and float switches,etc.) Na DrSTRIHUTION BOX: (tocate an size plan) Depth of liquid level above outlet invert: Na Comments. (mole If ravel ana distrlbution Is ccitial, evidence of eollds carryover,evidence of leakage into or out of box atc,) Na PUMP C!-IAMBER: (locate on site plan) Pumps ir.worldeg order;(yes or no)No Alarms in wofKing order(yes or no)w Comments: (note condition of pump chamber.condition of pumps and appurtdnances,etc.) Na IraHaed 0dr17787t 6 d l81 'ON WdlC l l CON 'S 'Ed SUBSURFACE SEWAGE DISPOSAL sYsTEM iriSPECTIAN FORM PART C SYSTEM INFORMATION continued Property Address. 175 Woodside Rd.Marstons Mills Owner: sbanoy Ingraham;17!$WoodsldeRd,WC5tBarhStIJICO2662 Date of Inspectlon:315198 SOIL F.B$ORPTION SYSTEM(SAS):x (locate on site plan,if possible:excavation not required,but may be approximated by non•inlrusive methods) If not determined to be present,cxplain Ma Type: leaching pits,number: onc1,000gaganiae6hpi` leaching chambers,number:r,la leaching galleries,number: da leaching trenches.number,length: rva leaching fields,number,dimensions:nla overflow cesspool,number:nr^ Alternate system: nti Name of Technology:_M Comments:(note condition of soil, signs of hydraulic failure,level of ponding.condition of vegetation,eta.) Loicnprznneana pan.ntiv.eeuaturatrysaunaandfunedanlnapreprny,TherelacurreAdV2,etwatarInn. CESSPOOLS:.� (locate on site plan) Number and configuration: Na Depth top of liatlld to inlet invert:nta Depth of solids layer: nra Depth of scum layer. WA DimensfLns of cesspool: nh Materials of Lonslructlon: Na Indication of groundwater, ria inflow(cesspool must be pumped as part of inspection) nfa Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,ate.) rta PRIVY;— (locate'on site plan) Materials Of construction: Na Dimensions: Na Depth of solids' r,ti Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Ni (re•beC Oe27157) 0l d 121 'ON W O : l l COH 'S 'EJ SUBSURFACE 59WAGE DISPOSAL SYSTErd INSPECTION FORM PART C SYSTEM INFORMATION(contlnued) 175 WOodSide Rd.I tarstonsmim Sheney Ingrah8m:171 Woodside Rd.west Barnstable o2668 3/5198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include Iles to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into douse) o � oe .4A kg 3� 43 e I (rovmoaoam�e� page 2 of 39 l l 'd 181 'ON _ . PH : l l LOH 'S '83d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FQRM PART C SYSTEM INFORMATION(continued) VS Woodside Rd.Marstons Mllis Sheriey Ingraham:175 Woodside Rd.West Barnstable 42668 316108 Depth of groundwater ,2, Please indicate all the methods used W determine High Groundwater Elevation; Obtained from design plans on record. Observation of Site(Abutting property,observation hole,basement sump em) Determine It from local conditions ChecK with local Board of Health Check FEMA Maps Check pumping records Check local excavators,installers Y Use USGS Data Oescribe in your awn words how you established the High Groundwater Elevation (MUST be completed) USGS maps and c.=U. rage 1Q of 10 (nvlseC Od1276+71 Z l d l8l 'ON ....... W 0 : l l LOH 'S '833_ TOWN OF BARNSTABLE LOCATION ZZ- � OSfI) iE'Dl�p SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&Pt;NftO. Z� 00 /q W 00 SEPTIC TANK CAPACITY l©� LEACHING FACE= (type) (size) NO.OF BEDROOMS Z BUILDER OR OWNER PERMTTDATE: 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 etland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished.by � Q r r F THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -'P�0�...........OF. . ........... ............ .. ........ .......................................... Ilk Application is hereby made for a Permit to Construct (/-,)"or Repair an Individual Sewage Disp al Syst at Location dd Owner I 'a Address nst Z Other Distribution box Dosiri'g tank 1.4 -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- The undersigned agrees to install the oforedeocribcd Individual Sewage Disposal System in u000rdnuoe with the provisions of Article XIof the State Sanitary Code—The undersigned further agrees not to place the system in operation until u Certificate of Compliance has been issued bv the board nfhealth. S' ------------ --_--_--__.-- ate Applicu6ou Approved Bv— --�-�-����� '������'-��^�..��--_ " - ' ~- nate Application Disapproved for the following reasons:............... —.--. -....................... � _-�--_-----_-'-'-_.____'--__---______---___'___'-_-''..---------__.-__'-_-_--._-'_-__ Date ' Permit Date ~-'-~-^---------------`'------------ -----''---- No..... ...... Fes ............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ... .. ....-...-.OF. .. ......----................ Appliratioat fin Disponl Works Tomi#rurtioat Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Systr at: 46 r' f Locatwn K duress i*3 Lo N Lf � ��', "rst'�jler-----•---•---- ..� .rw° - ddress Q Type of Bulawil Size Lot............................Sq. feet U Dwelling!No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtu es ._ -----------------------------------------•-- ------- W Design Flow________________________________ gallons per person per day. Total daily flow___-•_-___-__X-7,0;4�---------------------- Design P4 Septic Tank• Liquid capacity -:,�_ lions Length................ Width.-_._.._._..._.. Diameter-_-____-______ Depth_-______-_-_-_-- Disposal Trench o................... Width............. �'V`�Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... __lr............. Diameter_ .......... Depth below inlet__ Total leaching area__,,,%0_ /sq. ft. Z 'Other.Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by•---- ---------------------------...................................... Date-------------------------------------- ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___-____-_._____--___--- LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ _ ' . -----•---------------------------------------••-•-••-•••-••---••••••••-•--•--••-•------•----•-------------- O Description of Soil------------------- - ;47 ---- ------------------------------------------------------------------------- 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 Article XI 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 health. rSigned....................= .... --•------•------•--•--••----•-------••-.•-•-- ................................ t Date Application Approved BY ` - �r --- Z _•r----- -• - .- � �-- -- ---Date Application Disapproved for the following reasons---------------•------------ %;>?-------------------------------------------�......---------•-•--••-......•••-- ---------------------------------------------------------------------------------------------- Date' PermitNo------------------------•-----------••-•------•----••--- Issued........................................................ Date 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ."" ......s...........0F......... ... ............. (frr ifirtttr of Tlantlift aatrr TH ETD CER FY, That the ndiv j�ttal„Sewa. I al System constructed 11 y r Repaired b �"... e✓`� � ' °�' Installer _----_- = _ r_ at. °� S d •---•-• has been installed in accordance with the provisions of Article XI of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No.______•________________' __ __..__.. dated-_ _ _. _._.__ ..........__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR E® AS A 6UA +ANTEE THAT THE SYSTEM TI A�SFACTORY. � �/ DATE .•, ........................... Inspector_.............................. ....................L.. fit------. ' THE COMMONWEALTH OF MASSACHUSETTS.\ y" u BOARD F HEALTH r tvz� OF . ... .. .................. FEE. 2 . Kt Ditipao l _Work , Tofistr #ioat rr_ Permission i s hereby e eby granted ' = >' ---- --------------------- to Construct.,( or Repair4 an Indivi ual Sewagfe�Dispi seal System Street + as shown on the application for Disposal Works Construction rmit �_ Dated___ r'�`' ` .. 7�1_, . �—a�I Board of Healt" l,�g , f DATE ---------------------------------- --------- ; f a� Jl • �'`` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ' TOWNtOFBARNSTABLE �F V` LOCATION � W0®45.'Ae A'tk e SEWAGE # O09" a33 VILLAGE 1 �`�' � ASSESSOR'S MAP & LOT7 0 /�-0 0 INSTALLER'S NAME&PHONE NO. "T 6, . Ho SEPTIC TANK CAPACITY ;Z 6'00e', LEACHING FACILITY: (type) 6-4'0 j� e A4,v ee-f (size) �5—y at I3,X 2 N0.OF BEDROOMS BUILDER OR OWNER k t4 Ile PERMITDATE: /�7�0�' COMPLIANCE DATE: — 31-7109 Separation Distance Between the Maximum Adjusted Groundwater Table to the Bottom f 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 %7� filJov�S��e R� _ t Rear p-,F l��usQ 13 /3 3a r I 30 - 5 73 17� TOWN nn OF BARNSTABLE LOCATION 175���0 OC ��,�cJ'.e ZaG( SEWAGE # VILLAGES S�oI75 -L�i�i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Woo SEPTIC TANK CAPACITY LEACHING FACILITY: (type) —'P� (size) NO.OF BEDROOMS �� 1/!? BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by rER:COMPLETE THIS SECTION • • ON DELIVERY 11111 Complete items 1,2,and 3.Also complete A. S' nature item 4 if Restricted Delivery is desired. X Agent .■ Print your.name and address on the reverse C> ddressee so that we can return the card to you. B. R c i by(Prin Na ) C. Date Delivery ■ Attach this card to the back of the mailpiece, ; Z( or on the front if space permits. D. Is delivery address differe m item 1? [Pies + 1. Article Addressed to: If YES,enter delivery address below: ❑No 1 i lk)R-[1-Ur� t�J� r)slX� W 3. ceType rtified Mail ❑Express Mail. b b p ❑Registered P�9etum Receipt for Merchandise ❑Insured Mail ❑C.O.D. ~ 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number —H_ ;t= ; s ! } (Transfer from service labeo 7 0 0 6 0 810 0 0 0 0' 3 5 2 4 �714 4 PS Form 3811,February 2004 Domestic Return Receipt 102595-o2-.M 1s401 I i M UNITED STATES POSTA .SERVICE. F4r3C} sMatl . k xs: _ e .Pti tags 8t fees.( Id y_„ ... t,.• .� i;; `,','' Wmit No.G-10 .i. � h;F.)...rt, 9� .' :K_:� dal{n•..•.:._..."t:.�t(�,:,� I :::HA...-i�^_ . •::•:,I:tfk': 't'1::: 1. :'h'.•.,"'. I • Sender: Please print your name, address, and ZIP+4 in this box'* ! I I I I I i I I I , 79�1C � Town of Barnstable I Health Division 200 Main Street I Hyannis,MA 02601 I I I I I I I T1'I'i 11Irr1'rr11 r 1,1.1111'itrrrritrrrtri'VII1111ti`rrt'1Ilrr1i111�1��1 -U S PostalService, FC�F TI IED MAILTM RECEII (Domesf, Ma►, n/'No'Insurance Coverage Provideo ._' �,For`delivery informationhwsit"our�webs�te at www'usps.corr� � ��_�,� PSxForm 3800,June 2002 ' 't "See R ve ease o In'structio ns Certified Mail Provides:■ A mailing receipt (es-aid)z046Z sun r bolls uuo_A Sd ® A unique identifier for your mailpiece • A record of delivery kept by the Postal Service for two years Imtdortent Reminders: IN Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. • Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e 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 38111 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 LISPS®postmark on your Certified Mail receipt is required, is 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-DDelivery. • If a postmark an 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. tl@IPORTANT: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 J �� v-020 C 12— � aid � �� I, a f Town of Barnstable F Regulatory Services Barnstable C THE Tp� Thomas F. Geiler, Director ;mericaCity Public Health Division * �NMASSS. * Thomas McKean,Director V__+� 1639. �0� 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fa 508-790-63 Sent Via Certified Mail. 7006 0810 0000 3524 7144 December 7, 2012 Walter S. and Deirdre C. Kyle 175 Woodside Road 1 � ' + III West Barnstable, MA 02668 As of October 1, 2006 a new rental registration ordinanc was put into affect requiring all property owners of rental units to register their rental u��' s with the Town of Barnstable Health Division. According to our records, you own the re al property at 175 Woodside Rd., West Barnstable, MA. Enclosed is an application. Ple use use a separate application for each rental unit you own. Should you need more app 'cations, they are available online at www.town.bamstable.ma.us. Go to the Health Di ision page by looking in the Department Menu. There is a.link to the Rental Registration i9iformation on the Health Division page. You may print out as many as you need, and return't m to the Health Division with the appropriate 2012 fees included. This must be complete within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your cooperation. I Karen Herrand Division Assistant Public Health Division Direct#508-862-4072 Town of Barnstable THE of , Regulatory Services Barnstable T Thomas F. Geiler, Director ;mericaCity Public Health Division Q f Dro * BARNSTABLE, 9Q- MASS. Thomas McKean, Director Zoo; vOl i639' 200 Main Street FD MPS Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 25, 2008 Mr. and Mrs. Kyle 175 Woodside Road West Barnstable, MA RE: Septic Permit To Whom It May Concern: The Septic Permit # 2008-033 issued from the Public Health Division January 29, 2008 has been completed and a Certificate of Compliance was issued on 3/07/08 to the installer, J.C. Aalto Construction. The septic permit # 2008-033 is for 175 Woodside Road, West Barnstable, Map and Parcel # 127-030-T00. The septic permit shows it was constructed for 7 bedrooms, design flow provided is 773 g.p.d, and the engineering firm who designed the plans was Down Cape Engineering. I hope this information will be sufficient in answering your inquiries. If you have any other questions, please feel free to contact me at 508-862-4644. Thank you. Sincerely, Sharon Crocker Administrative Assistant Public Health Division t o7- z�i Town of Barnstable �a Regulatory Services Q; Thomas F. Geiler,Director KAM ' Public Health. Division 1e59. }�� Thomas McKean, Director 200 Main Street,Hyannis. MA 02601 Fax: 508-?90-6304, Ofn-ce: 508-86=-4644 Installer d DesiQner-Certification Form Date: SeR,age Permits (7(Assessor's Map\Parcel Installer: e a- Designer'. 0 W n _-rZFK'4'i--- "� Address: 9 Address: FO 0 fiox 3 y 4/y-m v4L (6,1Z M 1+ On was issued a permit to install a (date) (installer; septic system at 7-5WGb�XJ '�`Q �1 ✓2 based on a design dra�'n by _ (address) dated (design I ceran° that the septic system referenced above was installed substantially according to the design; which ma; include minor approved changes such as lateral relocation of the distribution box andlor septic twill, I certify that the septic system referenced above was installed with major changes (i.e. ,greater than 10' lateral relocation of-the`S!'�SS�te�B:vertical Local Regulations.f any Plan reins on or of the septic system) but in accont rdance with certified as-built by designer to follow. M OF�MSS9cyG ._ .. ARNE H. OJALA (Installer`s Signature) CIVIL N No. 30792 N A� ffix Designer's Stamp Here) (Designer s Si lure) (-a PLEASE_ RETURN TO BARNSTABLE PUBLIC HEALTH RTIFICATE OF COMPLI,aNCE VILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DI\VISION. THANK YOU. Q:Heahh/Septic/Designer Cenif cation Form 3-26-04.6oc NO. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS pplication for �Bigoga.Y *pgtem Con0tr Ction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. /y Sp Woo��5,�{ /�� Owner's Name,Address,and Tel.No. Assessor'sMap/ParcelV3 al _OD /7i7WvoW57,',4 A /W, Installer's Name,Address,and Tel.N Designer's Name,Address and Tel.No. Ig4lfo Low r�v✓cy�°`, ��130� 335rlArs?oqs ,✓!./f �0.2GY� y3y�4,� s� Y� ,..,�y6 b� � � Type of Building: Dwelling No.of Bedrooms 7 Lot Size e/G, 7y/ sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �f TO gpd Design flow provided 773 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5,,e P14.-7 Nature of Repairs or Alterations(Answer when applicable) ,SPP IA Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa of Health. Signed Date 5;-- Application Approved by / Date Application Disapproved by: Date for the following reasons Od Permit No. Date Issued No. .a °V�l !y1. Fee THE COMMONWEAL-TH,OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -`TOWN OF BARNSTABLE, MASSACHUSETTS Yes ' 010plication for �Digpool *pgtem Con�tr c ion Permit I 1 , Application for a;P.ermit to Construct O Repair( )\.Upgrade( Abandon( .Complete System ElIndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7iO3 _0,o !. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. PR/fo� 335,C9di37o�s .�?,r/r 14V0.761 y39�4. :, Sx. XA14 40 Type of Building: I y y Dwelling No.of Bedrooms Lot Size '1/G, 7y/ sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '7-70 gpd. Design flow provided 773 gpd Plan Date Number of sheets Revision Date Title .n. Size of Septic Tank Type of S.A.S. Description-of Soil - m. Nature of Repairs or Alterations(Answer when applicable) Datelast inspected: z Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa • of Health. Signed Date l' �— Application Approved by / v i Date Application Disapproved by: Date , for the following reasons Permit No. "'� Date Issued --——————— 1—————————————————— - L—————————-- THE COMMONWEALTH OF MASSACHUSETTS — BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (✓) Upgraded ( ) Abandoned( )by ^C / o L� S r�c f. at / 7C W11 11d ,•a oa ha been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r'•' dated Installer 37 C, A. /fo Designer J�v n Desi - � g � ., '.-, r #bedrooms '7 Approved design flow / and The issuance of this permit s 11 no be c trued as a guarantee that the system w'I fu on��sdJ/sgjn�/�. Date Inspector / G l/� - ✓7l� .,�' ?//1.'�I ------------------------------- No. � - (/..�� - Feei� THE COMMONWEALTH OF MASSACHUSETTS 0— PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Mwigpogar 4y5tem Cow5truction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) A.andon ( ) System located at 7 Ll✓�J and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. J Provided: Construction must be pomp a ed within three years of the date of thi it f� Date I u1 t �i Approved by I - s SYSTEM PROFILE NOTES LEGEND TOP FNDN. AT EL. 146.6' ALL ACCESS GONERS TO WITHIN 6" OF FIN. GRADE ( ACCESS COVERS To.wRHiu 3" of FIN. GRADE ACCESS DATUM fS APPR-OXtMATE NGVQ 100.0 PROPOSED SPOT ELEVATION AccEss COVER (WATERTIGHT) To C.O.=CLEAN OUT WITHIN 6" OF FIN. GRADE (SEE VENT NOTE ON PLAN) MINIMUM .75' OF COVER OVER PRECAST 2X, SLOPE REQUIRED :OVER SYSTEM 144.0 2. MUNICIPAL. WATER IS EXISTING tie �9 0 ©��P I 100x0 EXISTING SPOT ELEVATION PROPosED 2;zQQ *A=14, 2't RUN PIPE LEVEL 2 DOUBLE WASHED PEASfONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. r t 0 GALLON SEPTIC OR GEOTE MLE FABRF� =144:3 t FOR-FIRST-2' PROPOSED CONTOUR TANK (H- 10 ) ff 17- 4. DESIGN LOADING FOR PRECAST SEPTIC TANK TO BE 100 EXISTING CONTOUR. . �. 140. 140:17' - 40.09' 8. �uMP � 139.0' AASHO H-10, DBOX AND.LEACH CHAMBERS-TO BE H-20. GASag ~ 1540 GAL' MIN. BAFFLE 138.41' 138.24' 5. PIPE JOINTS TO BE MADE WATERTIGHT. ooay r38 .0' :OpQQ p . p`ppp o. MIN. (2.OX SLOPE) �6" CRUSHED STONE OR MECHANICAL p C3 O 0 a C1 C3 0 ED 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH COMPACTION. (15.221 [21) 2' MASS. ENVIRONMENTAL CODE TITLE V. �- DEPTH of FLOW = 4 , . 0 � 0 � � O O � Q. � 136:0 LOCUS. TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO INLET DEPTH = 1Q- BE USED :FOR -LOT LINE STAKING OR ANY OTHER -PURPOSE..... OUTLET DEPTH = 14 ( 7 X SLopEa ( 1 X SLOPE) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. A=18' LEACHING i 5.5' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED FOUNDATION SEPTIC TANK 24 D BOX 26 B=55 FACILITY. WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. II LOCUS MAP 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING SCALE: 1 = 2,000't *THE INSTALLER SHALL VERIFY THE DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION ALL SYSTEM COMPONENTS SHALL BE BOTTOM TH-1 EL. 130.5 LOCATIONS. OF ALL_UTILITIES. AND. ALL. OF ALL. UNDERGROUND & OVERHEAD UTILITIES PRIOR TO / BUILDING SEWER OUTLETS AND ELEVATIONS MARKED WITH MAGNETIC TAPE OR ASSESSORS MAP '30 'PARCEL T-00 ' © PRIOR TO INSTALLING ANY PORTION OF COMPARABLE MEANS FOR FUTURE LOCATION. COMMENCEMENT OF WORK. SEPTIC SYSTEM ' 11: EXISTING LEACHING FACILITY SHALL BE `PUMPED AND LOCUS IS-WITHIN AP OVERLAY DISTRICT REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ` 12. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE TEST HOLE LOGS REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. DAVID FLAHERTY R.S., SE2755 ENGINEER: 13. NO KNOWN POTABLE :WELLS WITHIN 150 OF PROPOSED WITNESS:. DONNA MIORANDI, R.S. 4QZ LEACHING FACILITY. DATE: NOVEMBER 27, 2007 14- COORDINATE REGRADING WITH OWNER'`PRIOR TO' PERC. 'RATE _ < 2 MIN/INCH SUBMITTING BID FOR WORK. • _ CLASS I SOILS P# 12014 Q ELEV. ELEV. . , 4 SYSTEM DESIGN: o" 142.5' 0" 4 142:5' BENCH MARK - CORNER OF - PAVED DRIVE . FILL A LL CONC. PATIO EL. = 146.2 16" 16" SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED DESIGN -FLOWt _7 BEDROOMS ( 11 Q GPD) _ 770 GPD* USE A 770 GPD DESIGN FLOW * S S (INCL. IN-LAW APT.) C.O. SEPTIC TANK: ; 770 `GPD '(2 ) = 1540 1OYR 2 1 LOT 34 � / 10YR 2/1 46,741 t SF ADD A 2500 GALLON DUAL COMPARTMENT TANK 22" 23" �c 1.1 t AC. �, TOWN WATER- / (PRIMARY COMPARTMENT: 1666 GAL./SECONDARY COMPARTTMENT: 834 GAL.) B g / \ (DUAL COMPART. REQ. >SINGLE FAMILY) - LS LS c EXISTING 7 ABOVE LEACHING: \ BR GROUND 10YR 4/6 47 10YR 4/6 138.6 C 2(59 + 12.83) 2 (.74) = 213 48" 138.5' / \ POOL.. SIDES: DWELLING _ c> TOP OF ��� ,� �� ���-:J__- �59_x 12.83 ( 74.�-�.= 560 ;. / SLAB"EL. ay S - DECK ��. 146.6' TOTAL: 1045 S.F. 773 GPD • USE (6) 500 GAL. LEACHING CHAMBERS ACME OR PERC 'DECK � -` , ® EQUAL) WITH 4 STONE ALL AROUND FLS FLS 2.5Y 5/6 2.5Y 5/6 144" 130.5= 132" 131.5' ., , ` 146 H TH-1 � STONE WALL NO, GROUNDWATER. ENCOUNTERED: ! _ rn AT GARDEN �r (SAVE) VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH• MAY BE IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR BY HEALTH INSPECTOR: I ti �w BOULDER N PAPERWORK AND HEARING REDUCTION PROPOSALS �a2 « ' APPROVED BY THE BOARD 017, HEALTH -REVISED= DURING A �� •..« 146 PUBLIC HEARING HELD ON NOVEMBER 15, 2005 147 148 3) FAILED SYSTEMS ONLY - SOIL ABSORPTION SYSTEM INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW GRADE WITH PROPEL VENTING- (PIPED TO =THE ATMOSPHERE) . TITLE � SITE PLAN : ,tea AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE S&S .°` BE LOCATED MORE THAN FIVE FEET BELOW GRADE. OF ! i 175 WOODSIDE' RD. I!, PROVIDE VENT WITH CHARCOAL•:FILTER AND BUGSCREEN (FINAL PLACEMENT WITH ' HOMEOWNER CONSULTATION) r (WEST) BARNSTABLE, MA PREPARED FOR DIERDRE KYLE TOWN' WATER DATE: NOVEMBER 27, 2007 REV. DATE: JANUARY 28, 2008 PROFILE ' Scale_1"= 20' ' 0 10 20 30 40 50 FEET O off`508-362-4541 fax 508 362-9880 TOWN WATER 1 ��H of MAS. ����H ofMgss9c II/ DANIELA. DANIEL C/ O Wn C�7p e erg g rl e erir� q, Inc. F A. �i U OJALA a OJALA IL No.40980 Cl VIL ENGINEERS c STE���� n. RF S\O pQ ( �Z�w$ Fss NA �aG No v LAND SUR VE-YORS DATE DANIEL A. OJALA, P.L.S. 939 Main Street - YARMOU THPOR T, MASS. SCE #07-284 07-281 KYLE.DWG (DDF) , I I