The URL can be used to link to this page

Home My WebLink About0703 OST.-W.BARN. RD - Health -79 70 3-0�s-t 6 ,Mbrstons Mills' F/R A = 123 046 - -- - - I TOWN OF BARNSTABLE LOCATION 5 LLA U —,/,SEWAGE # VILLAGE 01/1 Z T23/V5 0 -ELLS ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. .O 0 / _ . SEPTIC TANK CAPACITY OU0 I LEACHING FACILITY: (type)2 °5X Z-60 size)' A.2 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 4--ce COMPLIANCE DATE:, Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by h�a??J SOS If .L_. x IL T TOWN OF BARNSTABLE LOCATION 7-03_ -LtA 6MQ SEWAGE # 00 -III VILLAGE l'�'1/t2STaS /'1l LLLS ASSESSOR'S MAP & LOT :® d0 INSTALLER'S NAME&PHON,r W, /E NO. fl WrV-- �4Q45M / SEPTIC TANK CAPACITY c o LEACHING FACMITY: (type) co L.m 65(size) 13 X 2 Z b NO.OF BEDROOMS BUILDER OR OWNER �VAI tj--�6EUW PERMITDATE: COMPLIANCE DATE: 2-14.1�® Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by P , 3 r�� No.��nc�` !d�;R- � Fee as THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Miquar *potent Construction Permit Application for a Permit to Construct( )Repair(,-/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7c)3 0Sl1,Rlr U4L— W,,619j& Owner's Name,Address and Tel.No. Assessor's Map/Parcel g a ✓ P'n , M, 70 Wy �6 Installer's Name,Address,and Tel.No. 6R ", !/7V t L Designer's Name,Address and Tel.No. ,1,0 7R&Too 61A_ ► P5ToN 5 mj�e ao Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /OA90 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Tly! 1AzL _5Co 619u-aw L`61�%# 7.&55 t&l"t 1 9.1 S?zxyZ iVEc�. DZ 3 Date last inspected: Agreement: The undersigned agrees to ensure the construction and m ' tenance of the afore described on-site sewage disposal system in accordance with the provisions of Ti of th iron al Code and not to place the system in operation until a Certifi- cate of Compliance has been issued s B f He Signed Date �cG Application Approved by Date 7), A Z - 116 Application Disapproved for We follo ing reasons Permit No. �Xwo -- � Date Issued . �.o No. — — +... Fee r u THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for-Dizpozal *pgtem Conotruction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7f�3 �ST�RLI (r/,a�� Owner's Name,Address/an,,d,�gTel.No. Assessor's Map/Parcel r !J d � � �►, vA2a9�/ �R�/-"`�&A Installer's Name,Address,and Tel.No. /rYo7� Designer's Name,Address and Tel.No. ao 7R&TVP 61a2 ► 19RSTo#5 mru5 Qo- Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /4ZO ` Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A Tw_�2 6Cp 619aall f v1IV y' S7W-44 ,NEw a !L 3 Date last inspected: Agreement: The undersigned agrees to ensure the construction and m ' tenance of the afore described on-site sewage disposal system in accordance with the provisions of Titl of the�n�ironm tal Code and not to place the system in operation until a Certifi- cate of Compliance has been issued is Bohr f He — Signed Date Irq'GG Application Approved by Date. Application Disapproved fort foll ing reasons Permit No. 'h 00C2 1 Z -, Date Issued ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE , that the On-site Sewage Disposal System Constructed( )Repaired( (.)'Upgraded( ) Abandoned(e )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer aa0h [ 4017-/Z_ Designer A 41 0) /) 0 �. The issuance of this pe shall not a construed as a guarantee that the s tam Viimct' n as do igned 1 1))14A)LIP��)Date .� Inspector l V �mot/ . --------------------------------------- No. �wrLl1 _ Fee 0 ° THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po5ar *VOtem Construction Permit Permission is hereby granted to Construct( )Repair( 4Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date:a Approved by 'O 1i6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated S2::&-06 enh property located at meets all of the following criteria: Ir `• The failed system is canner ed to a residential dwelling only. There are no commercial or business uses associated with the dwellins. �• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. �• There are no wetlands within 100 Pert of the proposed septic system �• There are no private wells within 14�0 fert of the proposed septic system �• There is no increase in flow and/or change in use proposed �• There are no varianc= requested or needed. �• The bottom of the proposed leaching facility-will not be located less than five feat above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable], \• If the S.A.S. will be located with 250 fee:of anv vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Too of Ground Surface Elevation(usin;GIS information) B) G.W. Elevation the�t��. High G.W. Adjustment . _ 2 " D=cRENCE BETWEEN A.and �® SIGNED : DATE. 0i -06 (Sketch proposed plan of system on back]. q:hcslth Colder.c-t Ij /000 69L Ttvk 0 Q 0 OLD V~ / `q6H - ------------ TOWN OF BARNSTABLE `\ LOCATION 7-03 nSj �— Ur 046ZLMSEWAGE # cc yy� r VILLAGE / 'L/�2STb/VS LDS ASSESSOR'S MAP & LOST.\ INSTALLER'S NAME&PHONE NO. L 01V 4&0Trz- 4�0:k3 S . SEPTIC TANK CAPACITY f OU0 LEACHING FACILITY: (type) #�� I� �s(size)' n-2jf- ° NO.OF BEDROOMS- BUILDER BUILDER OR OWNER O PERMITDATE: COMPLIANCE DATE: 2 1 '®® Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist i within 300 feet of leaching facility) Feet Furnished by --J 9 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTickeL Ma. (508)564-6813 �NSpE�T�p� TRUDY COXE �"ED Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 703 OSTERVILLE W. BARNSTABLE RD. CENTERVILLE Name of Owner FREEMAN I- Address of Owner: 790 FALMOUTH RD.HYANNIS WHITE HALL ESTATES MA.02601 Date of Inspection: 12/17/99 Name of Inspector:(Please Print)JOHN GRACI -f �EwEO I am a DEP approved system inspector pursuant to Section 15.340 of Tifle 5(310 CMR 15.000) ,� > Company Name: n/a p F Mailing Address: n/a Telephone Number: n/a' TOWN OF BARNSTABLE HEALTH DEPT. CERTIFICATION STATEMENT 1 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 The inpection Is based on criteria defined In Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system Is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My Inspection does X Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:12/i7/99 The System Inspector sha I submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 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. NOTES AND COMMENTS THE SYSTEM FAILS TITLE V INSPECTION.THE SYSTEM IS IN HYDRAULIC FAILURE.THE PIT SHOWS SIGNS OF BEING FULL. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: nla B. SYSTEM CONDITIONALLY PASSES: Wa One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N;or ND).Describe basis of determination in all instances.If"not determined",explain why not. nta 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 complying septic tank as approved by the Board of Health. Wa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) 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 Wa 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 revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 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 IN ACCORDANCE WITH 310 CMR 16.303(1)(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa. (approximation not valid). 3) OTHER nLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: X I have determined that one or more of the following failure conditions exist as described 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n&. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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 ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. 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 system does not receive non-sanitary or Industrial waste flow. X 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.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 FLOW CONDITIONS RESIDENTIAL Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):A Total DESIGN flow: IV Number of current residents:A Garbage grinder(yes or no):]I'E;i Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no),M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): NO Last date of occupancy: 711/99 COMMERCIAIJINDUSTRIAL Type of establishment: n/a Design flow: n&gpd(Based on 15.203) Basis of design(low: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): rLQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n/a Last date of occupancy: n/d OTHER: (Describe) n/a Last date of occupancy: Na GENERAL INFORMATION PUMPING RECORDS and source of information: n/a System pumped as part of inspection:(yes or no):MQ If yes,volume pumped n(a. gallons Reason for pumping: n& TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: Wit APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS 27 YEARS OLD Sewage odors detected when arriving at the site:(yes or no): NO revised 9098 Page 6 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1.6.. Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: n1a Comments: (condition of joints,venting,evidence of leakage,etc.) Wa SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n1a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No nla Dimensions: L 8'6"H 5'7" Sludge depth: L" Distance from top of sludge to bottom of outlet tee or baffle: M Scum thickness:-Q Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Q 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,RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED EVERY TWO YEARS, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n1a Dimensions: n1a Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:-n1a Distance from bottom of scum to bottom of outlet tee or baffle nla Date of last pumping: WA 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& revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nta Capacity: n& gallons Design flow: n(a gallons/day Alarm present: NQ Alarm level:.nLa. Alarm in working order:Yes_No_: DLO Date of previous pumping: nta Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nLa DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:Wit Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) n& PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2/98 Page 8 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n!a Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: jila leaching galleries,number: _n& leaching trenches,number,length: n& leaching fields,number,dimensions: WA overflow cesspool,number: n/a Alternative system: n(a Name of Technology: _nta Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS PAST THE EFFECTIVE DEPTH OF LEACHING-THE LIQUID LEVEL HAS BEEN OVER PIPE CESSPOOLS: _ (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: nta Depth of solids layer: n/a Depth of scum layer. nla Dimensions of cesspool: n& Materials of construction: n(a Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa PRIVY: _ (locate on site plan) Materials of construction:nta Dimensions:nta Depth of solids: nta Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Wa revised 9/2198 Page 9 of 11 r� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a �5t AA 33 �c31 0 �53 revised 9/2/98 — Page 10 of 11 A � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 703 OSTERVILLE W.BARNSTABLE RD.CENTERVILLE Owner: FREEMAN Date of Inspection:12/17199 NRCSReportname: nta Soil Type: n1a Typical depth to groundwater: n(a USGS Date website visited: n& Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9/2/98 r Page 11 of 11 Yu ru a PostageLrI _0 Certified Fee E 0 Postmark Return Receipt Fee •� �� Here M (Endorsement Required) C7 O Restricted Delivery Fee �+ b (Endorsement Required) �f Total Postage&Fees $ �' ° `-• Yu C3 Sent To CJ Gregory D. Drew a O �t: --- Street, 819 Sumner Ave. O or PO Box No.. i O City Stale,ZIP S rin field Ma. 01108 :°° °° Certified Mail Provides: C A mailing receipt n A unique identifier for your mailpiece y o A signature upon delivery r o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. , o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to Provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. to For an additional fee, delivery may be restricted to the addressee.or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If.a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.* ! PS Form 3800,January 2001(Reverse), 102595-01-M-1049 I - - Pv�j"E rqw� Town of Barnstable Regulatory Services * BARNSTABLE; *, Thomas F. Geiler,Director v 9 Public Health Division. Arfo��A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 V Fax: 508-790-6304 i Gregory D.Drew Date: April 29, 2004 819 Sumner Avenue Springfield,Ma. 01108 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 703 Osterville WBarn Rd., Centerville was inspected on, 12/30/99 by John Graci a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The SAS of the septic system was in hydraulic failure. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or,registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office (Regulatory Services, 200 Main Street,Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are also ordered to upgrade or replace the septic system within six mot (180) days of your receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of. requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board of Health. PER ORDE T BOARD OF HEALTH s . McKean,R.S., C.H.O. Agent of the Board of Health CC: Board of Health 1A6kd_septic�etters Septic Inspection Information :::::::.;>; .;;;;;;;;;;;: 12/30/1999 1123 1046 > 1>a Centerville John Grad IF ........................ ........................ iEet> The pit shows signs of being full. ....................... AW OW �� Ov