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HomeMy WebLinkAbout0033 HIGH NOON DRIVE - Health (3) 6 JUDITH EVE LANE, CENTERVILLE A= 193 229 lIII UPC 12534 No.2 '`�sT coeds HASTINGS,MN r BAXTER & NYE, iNC. Professional Land Surveyors and Civil Engineers 812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX(508) 428-3750 WILLIAM C.NYE, P.L.S. -President PETER SULLIVAN, P.E.-Vice President-Engineering RICHARD A. BAXTER, P.L.S.-Vice President SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector: Peter Sullivan PE (}Location : �6.Judith_Eye Lane Centerville (aka33 High Noon Drive)- r _ _ —_ _ _ Date Febrary 22,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance.and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the.FAILURE CRITERIA section of this form. truly yours O eter Sullivan PE Baxter & Nye Inc. Of Distribution: Original to system owner ;' PETER Buyer g SULLWAFt rBoard of Heath No. 29753 MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS G C- ��= 33 tc ono ewe SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , Address of property Owner ' s name Date of Inspection PART A CHECKLIST Check if the following have been done: Pumping . information was requested of the owner, Health. occupant, and Board of -None of` the system components have been pumped for at least two w and the system has been receiving normal flow rates during that eeks Period,,.. , barge volumes of water have not been introduced into the system ,re(,�ently or as part of this inspection. As built `plans have been obtained and examined. Note if they are not available with N/A. "OZ- The facility .or dwelling was inspected for signs of sewage back-up. P The site, was inspected for signs of breakout. A11 sys:tem ' components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior the septic tank was inspected for condition of baffles or tees, of material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing. information' or approximated by non-intrusive methods. The facility owner (and occupants, if different from Provided with information on the proper maintenanceOfwSSDS,were a ,'HUDSURFACE 13EWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If resid,entia'l; number,,;of`: bedrooms number o.f:, current.. re-sidents garbage, :grinder, yes or no laundry.:connected to system, yes or no 1�Ecp11V'-11' - seasonal,,;,use, yes or no If nonre,siderytial , calculated flow: S�G�`r"`'"�r - �' Water meter readings, if available: A ,Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or no if yes , volume pumped IZ5 Q q Reason for pumping: Nvt At Arr Ty e of system;; Septic: tank/distribution box/soil absor ti Single cesspool P on system Overflow. :cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) P on Other (explain) Approximate. age .D of all components. ate installed, if known. Source of D V7 l�)eG S Sl �l Yv S� Sewage odors detected when arriving at the site yes or no LJ E 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued ' SEPTIC TANK: 1 SDD (locate on site plan) r depth below grader 2�sa 25 material of construction: _,&_concrete metal FRP other(explain) dimensions: 1� �` D� �'` Q�•� � ' 1,lQV�fl to'+ sludge depth distance from top of sludge to bottom of outlet tee or baffle �Z scum thickness distance from top of scum to top of outlet tee or baffle Z distance from bottom of scum to bottom of outlet tee or baffle 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, recommendations for repairs, etc. ) � A P 6 fl �Ys 1c �0� v rU S cx� DISTRIBUTION B01XS (locate on',, it.e,,.p;,an) +� iruUC-2T depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leaka e into or out of box, recommendation for repairs, etc. ) =;.......................... PUMP--.'CHAMBER: (locate on,' site plan) pumps in working order, yes or no Comments : (note condition of pump chamber, condition of zal and appurtenances, recommendations for maintenance or repai , c. ) J v a rK Ev 0 ),AkZ 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION co ntinued ued SOIL -ABS �-�ORPTION SYSTEM (SAS) : (locate on' site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) I not defterm"ined to be pre-sent, explain: ,E)CA (� TT(E i TS +J Zr C3 ti _ FL rU ' .� � � �' - '�2LUA • Type leaching :p` ta; and number r leaching2�tT'� �� Z � C �- .chambers and number �c�tcsU� leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil , signs of hydraulic failure, level of ondi � condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS ,,(locate on site plan) : number and configuration I� depth-top .of liquid to inlet invert depth of solids layer depth of scum layer dimensions of .cesspool materials 'of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: : (note condition -of soil, signs of hydraulic failure, level of pondin condition of vegetation, recommendations for maintenance 'or repairs g� ,etc. ) PRIVY: (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition. .of soil , signs of hyd_ is failure, - level of . o } condition of vegetation recommen P nding, ons for maintenance or repairs, etc. ) -- SUB-SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks lo�.ate all wells within 100 ' TOO moo , , DEPTH TO 'GROUNDWATER depth to groundwater method of determination or appro imation: G i ll 1 E E l�.A(UF, ` C E �-� 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes,' no, or not determined (Y, N, or ND) . Describe basis of. determination in all instances. If "not determined" , explain why not) Backup,, o.f sewage into facility? Distharge or pond`ing of effluent to the surface of the ground or surface waters? !fib Static liquid level in the distribution box above outlet invert? Liquid' depth in cesspool <6" below invert nvert or available vol 1/2 day Requ red pumping 4 times or more in the last year? �- number of. times pumped Septic' tank � is metal . cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? ISO Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? 4�6 within 50 feet of a surface water. V� with:1n . 100, feet of a surface water su water supply? pply or tributary to a surface © within a ^Zone I of a P. _ .ublic well? within 50 feet of a borderin g vegetated wetland or salt marsh jcesspools and privies only, not the SAS) ? within �5O .:feet of a private water supply weil? less than 100 feet but greater rom a supply well with no acceptable water 5quality 0 feet fanalysprivate If water has been analyzed to be acceptable, attach co e well for coliform bacteria, volatile r anic compounds, ammonia tnitroogger ensls and nitrate nitrogen. R;g 1 TOWN OF BARNSTABLE LOCATION6�_/6ea 6 cfue. SEWAGE # VILLAGE�e� ��>i��F? ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) q�46 NO. OF BEDROOMS PRIVATE WELL R=PUBLICWAT__Ek--�,, BUILDER OR OWNE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No AC Op 'J$ C(DU L-0 KAOT LQ_r64-T&' -POE _co 4- r DORi`OLO`iTI CONSTRUCTION, INC. 765 Wakeby Road MARSTONS MILLS, MA 02648 (508) 771-9399 (508) 428-8926 SEWAGE DISPOSAL SYSTEM EVALUATION Inspected By: Date: 02 935 sty 5 1617 !4ap & Lot# owner/Bu Mailing Address- NOTE: A satisfactory evaluation does not guarantee that the system will continue to function. A sketch of the property and sewage disposal components must accompany this form. RESIDENTIAL COMMERCIAL USE Lot Size: Lot Size: No. of Bedrooms: T Type of Business: Garbage Grinder: Water Softner• Sq. Ft. of Bldg.: Other Water Use': (Appliances) No. of Employees: Water Use Activity: Year Round: ,Seasonal: Water Santee: /D/,�) Water Source: Septic System Installed(Date): Title V Yes (Z--f No ( ) NO. SIZE LENGTH TYPE FT. TO FT. TO CONDITION WELL WETLAND Building Sewer Septic Tank Effluent Pipe Dist. Box jr7S�c�G Dist, Pipe , Leach-Pit Flow Difussars , Leach.Trench.. Stare Cesspool Pump/Chamber. Evidence of Ground Stain Yes ( ) No ( k-j Unknown ( ) Evidence of Breakout/Overload Yes ( ) No ( ✓).. Unknown ( ) Evidence of Overflow to Surface Yes ( ) No ( `) Unknown. ( ) Evidence of Lush Growth around Pit/Cesspool Yes ( ) No ( 1/r Unknown ( ) Standing Liquid in Pit 1/2 or More Fill Yes ( ) No ( �,. Unknown--_ ( ) Evidence of Excessive Pumping Required Yes ( ) No ( Unknown ( ) Z"%JD iTH EVE l AUE i 0 o L T ° 0 l 8 3s ± FuD 38't p ? N I s,� IS�Io . F 48 p'1{Pq�i�4gf Lo r Z.o 1 I RICHgRD ' BARTER - ►y gypgg - ' bsT Ica�'o4 �J b 17 CERTIFIED PLOT PLAN 'I CERTIFY THAT' THE C=ovQDATE o ,J LOCATION CCAjTC12-ViLt_,�� SHOWN HEREON COMPLYS WITH SCALE V=- 40 ' DATE (o- 2 - 8 � THE SIDELINE AND SETBACK ws-visLp) 8 - 2( -SG REQUIREMENTS OF THE TOWN OF PLAN REFERENCE DAIZ-JSI AI: L,E AND IS NoT �� LOCATED WITHIN THE FLOODPLAIN, T \9 k.13►L. 32(. 1:" 27 11C� DATE : (a-Z '8G BARTER e NYE, INC. THIS PLAN IS NOTBASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT ::, _ JUp► rlq t/� LA o ' DeI Ll r o w 11 d 4: .4 CEO 7oA5S 8a ,oo Z I SWIG TA14v- �D :-{ 2oa `Ja ' 0$O IrPD r-4 VSt� . 1Soo GAL. •hISPoSr�L ?Its - U69 Z- WO 9A Z' SrOrJ� `J I E�-glob vna �I hciw/a,C.L, /�r2<3� = 37(o Sf= `� _ . /oi ��A •°�'LJ 31l0 Sr- �t.2,5 = 4d0 6P� t_ •/on 3S• 40., �I¢ 12 i•� - 15 8 SF loo 641L 4s`ia° T 'P I-A L, 516 h1 I v q 8 6 po Y....,' .. Q. To T-A L t�A 1 L• I`�-ou.�. .~ w 6 Pri Pao N I 1 l ,i TAW,i � 1=iht;;� i R�°`T� • �'N '2 Mti] o(Z IrESS �� I 1 ��o _ ro3,e z Prr 1 I � pr t j /a� ��, t 93`�- 1 / I - (-I PETER a., i � I ��,(�IO Exp SULLIVAN o; 29�33 al 99 I r �N may. ` 0 k�h SAE L �'t` .2 D r EL=iv2, FG. ro3 G /p� M4- 77C. . , ZOAn� Sow /000 . oisr, l�asro) /500 � -¢ Ga[. / Box //Vt G.4L, IAI , gp•e. .SEPrrC 9 ',�'I LayN?S v' P,7 S �IAJS WRSHC-D •• G'.E,2T/F/EO PLOT �G4�✓ M ;b PRoFI �3 : _ 9 ' s �� OWN If—10 cic� No scaLE:� LoT 9 �o ,OW z-. , . yE.�Eo v coi►lP�ys / He- 326 pG z 7 .4Np.S�Tl/1G,e .e�QIJ/eENJ�N7:s Th�V,. ' Jf/it/ OF. BA/L�T,q BL.9 .e.E6�.fr�,p��.G4iv0.slietiE_y�.4S LDCdT•E,p poi 8.85 DA l/J O _"_----- T//lr,o�..e�f/ /s A/oT aAsEp oni,4W iY • -�/�l,Ei3/T.Svel/Eyst S'�J6 K/it/h�E��•ON NO T.SrE o�F,S�� T13 E.S�1dL/Sy Low.!./iY�oT!�E 02/27/1995 09: 32 508-428-3508 C. —.O.MM. WATER DEPT PAGE 04 i 03.11 CENT1•✓RVILLE-QSTERVILLE• SEND PAYMENT TO _ MARSTONS MILLS C-O•NIM WATER DEPT. WATER r WATER DEPARTMENT P.O. BOX 369 'Sy9DEPT.�y" P.O. BOX 369 1138 MAIN STREET OSTERVILLE, MA. sr0 CSTERV ILLS, MASSACHLISETTS 02655 TELEPHONE:(508) 128.6691 02655-0369 33 HIGH NOON DR i "^ SERVICE ADDRESS DUPLICATE COPY • ACCOUNT N0. CLEARY, DONALD & CECELIA 9232 33 HIGH NOON DRIVE CENTERVILLE MA 02632-2332 PLEASE PAY THIS AMOUNT L— P.LEASE MAU, CHECKS PAYABLE TO"C-04NIM WATER DEPT." TO INSURE PROPER CREDIT, PLEASE HEITURN THIS STI111 WITH PAYNIKNT This form made of recycled paper - - - _.— � —•� __ — RETAIN THIS PORTION to7li '() ! R.:('U l):i "- - - -- -_•-- r SERVICE ADDRESS ArVOLNT su }•ite is i ! 33 HIGH NOON DR , 9232 f \VATER BILLS UNPAID AFTER(30)DAYS FROM DATE OF ISSUE ARE . IB,IF.CT TO INTEREST c HARCES.AND TERMINATIQN OF SERVICE FOR ,c Rernr�.: ACCOUNTS PAST DI;F t1.20)DAYS.ALL IN ACCORDANCE WITH CEh'TERVILLE-OSTF,RVILLE-MA.RSTONS MILLS WATER DEPT.RULES )�1 f•;�E�T; AND REGULATIONS. c xnxc� DUPLICTE COPY � PERIOD COVERED PREVIOUS METER CURRENT METER CONSU.Nif 10N CURUNT FRONT I TO READING READING 1000'a OF GAL 7/1/94 12/31/94 313 _ i _ 400 ( 87 $15 . 00 QUARTERLY MINIMUM EXCESS CHARGE Z 194 . 30 RATES PER THOUSAND GALLONS 20 , 000 GALLONS FOR SIX MONTH PERIOD COVERED MINIMUM n* � $2 . 90 OVER 20K TO 200K JAN—MAR 95 CHARGE f 15 . 00 $3 . 95 OVER 200K 71. 1 9 5 oz,(iafi;>?vE 209 . 30 is tv .. S 02/27/1995 09: 32 508-428-3508 C..-.G.MM. WATEF DEPT PAGE 05 ```E_ °S CENTERVILLE•OSTERV7LLE- SEND PAYNIENT TO KA.RSTONS MILLS (;•0-yf�t WATER 1)E1't'• WATER r WATER,DEPARTMENT 3. DEPT P.O. 13())(369 - IUS MAIN STRFF'r P.U. BOX 369 ~�SrONS OSTERVILLE. MASSACI-IUSETT5 026,5+� ()STF;1tVlI.i,F.• MA TILEPHONE:(508)-12H-6691 02655.0369 33 HIGH NOON DR i - --'--'- SERVICE ADDRESS ----- ------J DUPLICATE COPY r. I A(•r'OUNT ya. CLEARY , DONALD & CECELIA 9232 33 HIGH NOON DRIVE _ CENTERVILLE MA 02632-2332 PLE•a$FRk't ,HISA'S1U(.'N',' 84 . 60 PI.A;AS>; NIAKF,CHECKS PAYAI31,1;TO WATER DEPT TO ENSURE: PROPER CREDIT. PLEASE: RIFT URN THIS ';TU 3 Will 11'.\YNIENT - -- -- - - - - - - - - This form ntadeo(rc'.ticlyd/�aper - - -- -- - -- -- - - - HFTAIN THIS P0FITI ILYL) Ft I h nS —•__I SERVICE ADDRESS 33 HIGH NOON DR 9232 \VATF.R BI1.1.5 UNPAID AFTER%70i DAYS FRUNI DATE OF iSS1.F.ARk: S1:13.17C.T TQ INTEREST CHARGES,AND TERMINATION OF SF.R�'IC F. F<)tt •i W tl' ' _OUNTS PAST DUE 120; DAYS. ALL IN ACCORDANCE WIT1.1 i ---- (;F-.N,rERVILLE•OSTERVILLE-A1ARSTONS MILLS WATER DEPT.RULFS AND REGULATIONS. DUPLICATE COPY_ _ PERIOD COVERED PREVIOUS METER CURRENT IiETER CO\sumr-T1GN CUR.RIENZ ~ FRONI-1 TO READING RF.,4 _ woo's OF GAL_�J CHARGES 1 1 94 6(�94 269 313 44 $15 . 00 QUARTERLY MINIMUM EXCESS CHARGE 0* 1 69 . 60 i RATES PER THOUSAND GALLONS pERIOf)COVF.RF.l) +lNlNfl'�t 20 , 000 GALLONS FOR SIX MONTHS JU.LY—SEPT9 ! �I1•aR(:e 15 . 00 $2 . 90 OVER 20K TO 200K $3 . 95 OVER 200K DATE OF 13SUE TAJL 7/1/9 4 AMUL'NT DUE °� 84 . 60 I I:I /2 i 1995 09: 32 508-428-3508 C. —.0.MM. 4)ATER DEPT PAGE 03 %vi.r o s ;QJ "�-- rF9L CENTERVILLE-OSTER.VILLE- S���YMENTTTO FtS w MATONS M1i.tUS C•O-MM WATER DEPT. WATER M WATER DEPARTMENT ?r, DEPT. y P.O. BOX 369 — 1138 MAIN STREET P.O. BOX 369 ASroN� �� OSTERVILLE, NIASSACHUSETTS 02655 OSTF RVILLE, MA TELEPHONE:(508?428-6691 02655.0369 j 33 HIGH NOON IQR �— SERVICE ADDRESS'- DUPLICATE COPY ACCOUNT NO. CLEARY, DONALD & CECELIA 9232 33 HIGH NOON DRIVE CENTERVILLE MA 02632-2332 PLEASE PAYTHIS AMOUNT 84 . 61 PLEAS MAKE CHECKS PAYABLE:TO"C-O-MIN't WATER DEPT." TO INSURk: PROPER C RFUIT, PLEASE RETURN THIS 5'I'lth WITH PAYMPNT This fore: made of recycled pape- �� _ _____ __ RlTFT ._t co ti— —in lh _ ._ _ ...... .^ —_ _ LIi SERVICE ADDRESS nt rut�T'n ' i I F'Itg�lul 33 HIGH NOON DR 9232 jjim":ctt i WAT=R MILLS UNPAID AFTER t34i DAYS FROM DATE OF ISStIF ARE SUR;F.CT TO INTEREST CHARGES•AND TERMINATION OF SERVICF FOR A.CREMTS mx0t'NTS PAST DUE(1'?0)DAYS.ALL IN ACCORDANCE %VITIi CENTERVILLE-OSTER�rlt.I_.F..•NIA.RSTONS MILLS WATER DEPT.RULES Ix'Cln;:�T AND REGULATIONS DUPLICATE COPY rw�Ri r; _ PERIOD COVERED PREVIOUS METER CURRE,17 hf>TER CONSUbif'TION Ci1RFfiEN'r `— FR0m i TCi _ READING READII 1004'a OF CAL, CHARGES 7/l /93 12/31/931 225 269 1� 44' EXCESS CHARGE 69 . 60 $15 . 00 QUARTERLY MINIMUM RATES PER THOUSAND GALLONS PF.RIODCOVER£D �g111D11 n1 20 , 000 GALLONS FOR SIX MONTH r JAN—MAR 94 I CHARGE 15 . 00 j $2 . 90 OVER 20K TO 200K $3 . 95 OVER 200K DATE OF• UE i TOTAL 1/1/9 h AMOUN i DUZ'.'" 84 . 60 4 i 02/27/1995 09: 32 508-428-3508 C. —.U.MM. �JATEP DEPT PAGE 02 �+8r SEND PAYMENT TO �,� CENTER�ZLLE•OSTERVYLLE• _ c MARSTONS MILLS C-0•blhi WAT WATER A ER DEPT. WATER � DEPARTMENT DEPT. " KO BOX 369 — 1138 .MAIN STREET P.O. LOX 389 O STERVILLE, MASSACHUSETTS 02655 OSTERVILLE,MA TELEPI[ONE:E508►428-6691 02655-0369 33 HIGH NOON DR SERVICE ADDREss ' DUPLICATE COPY aCCUUNT NO. CLEARY, DONALD & CECELIA 9232 33 HIGH NOON DRIVE CENTERVILLE MA 02632-2332 PLEASE PAY THIS AhEnUNT 1 L 23 . 70 PLEASE MAKE CHECKS PAYABLE TO"C-0-MNI WATER DEFT." TO INSURE PROPF;R CREDIT. PLEASE RF,TL;)'N THIS STUB WITI i I)AYm NT — —__ _ — __.. — This/bran made of recycled paper _ RETAIN TH15TQ�RT1 )N P(W YiWR RECORDS SFRVICF.ADDRESS ,.rrcx:Nz�'.9232 �k•It��ir;i':� 1 33 HIGH NOON DR i I i 14A�A.I t,i WATER BILLS UNPAID AFT,ER C30:DAYS FROM DATE OF ISSUE ARE SUBJECT TO INTEREST CH.�RGES,AND TERMINATION OF SL'Rb'ICI:FQR ark�ntr; ACCOUNTS PAST DUE i 120i DAYS.ALL IN ACCORDANCE WITH i CF..hTERVII.I.E-OSTERVILLE•MARS TONS MILLS WATER DEFT.RULES IINTLI(LSTF_ AND REGULATIONS. DUPL COPY PERIOD COVERED PREVIOUS METER CURRENT METER CONSEJAIRTION CURRENT FROMTO I READINGREADING 1000.8 OF_OAI. CHARGES 1/1/93 6/30/93 ' 202�^ 225 23 i $15 . 00 QUARTERLY- MINIMUM 1 EXCESS CHARGE RATES PER THOUSAND GALLONS 8 • 70 i 20 , 000 GALLONS PER SIX MONTH PERIOD COVERED I MINIML-NI CHARGE I $2 . 90 OVER 20K TO 200K JULY—SEPT�__ 15 . 00 $3 . 95 OVER 200K oi DATgt, �;'•.;�. . 7 1/93 'zv'E. 23 70 1 'I a