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Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director.
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 16, 2007
Estate of Mrs. K. Virginia Adams
c/o Mr. &Mrs. Luke S. Hunter
22 Old Colony Road
Wellesley,MA 02481
ORDER TO COMPLY WITH STATE ENVIROMENTAL CODE, TITLE 5
The septic system located at 123 Bay Street, Osterville,MA,was last inspected on
April 7"', 2004,by James M. Ford, a certified inspector for the State of Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines
of 1995 TITLE 5 (3.10 CMR 15.00) due to the following:
Single cesspools automatically fail in the Town.of Barnstable
Our records indicate that the necessary repairs and upgrades were not done in the
two(2) years given you at the time of the Health Departments order,
(April 41h, 2004). You were asked to hire a professional engineer or registered
sanitarian to prepare a plan of proposed replacements of septic system
component(s). This plan was to be submitted to the Town of Barnstable Public
Health Division Office (regulatory Services)within ninety(90) days of receipt of
that letter.
If you can provide a compliance certificate showing that this work was done; so that we
may update our records we would be grateful; if not you have 60 days from the date of
this letter 7/16/07 to'bring the system into compliance.
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i
Any person who shall fail to comply shall be fined not less than $10.00 nor more
than $500.00. Each day's failure to comply with an order shall constitute a separate
violation.
aBARNSTABLE HE DEPARTMENT
cKean.R.S., C.H.O.
Agent of the Board of Health
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No. 20
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Fee
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
application for 30iop0oaf bpztem Com6truction 3permit
Application for a Permit to Construct( , )Repair(t/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No., Q
Assessor's Map/Parcel
In /17 Par�.el ly9 9a 0/4 69k4y � , Guef/ems/ Mgoaj4p
Installer's Name,Address,and el.No. Designer's Name,Address and Tel.No.
e_ 00 Pr1S T_ wry&-J/r vac�j E/'�1 i o� �7>�
Type of Building:
Dwelling No.of Bedrooms Lot Size Lq...Ift�_sq.ft. Garbage Grinder( /Y0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design.Flow 336 gallons per day. Calculated daily flow gallons.
Plan Date Al o -10814 Number of sheets Revision Date N
Title �_&iK e-h "r4-faI i2_2> 11skryd l e, fZ'X U
Size of Septic Tank I Type of S.A.S. /e4Mj,n iA494-
Description of Soil �e'/ A1-8&iwr y/
-- " A bra IWWX &VrZP_ _'W nd_ §V r S/ --6 b nd %au dwric .V44A.-
��%� �" ®� a 4 . > came+ 6r� �a.sa sr�rt� �® < D . C. Sr ��ys •�f�
Q ,a®®-.14P C 3 �A/ vsh r� ,.e S r�� /6� i�aW ¢ ��>®,'s/, „• L � ::t4k ` *-r
Nature of Repai or A terattons( nswer when ap ica l
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 Certifi-
cate of Compliance has been issued ti s Board of al
Signe Date Ct
Application Approved by j Date
Application Disapproved Pfthe following reasons
t_
Permit No. Date.Issued
No. d �� x. -�-- } Fee 16 V
w THE COMMONWEALTH OF MASSACHUSETYS- -' Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Application for ;Migogar *pgtem Congtruction Permit
•t
Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No./.�3 �/ sf� �$I Gf y)J Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
704 rc el /yy r3,4 Old eo/any Rd� Gve//r3/e t?�p od y�/
Installer's Name,Add ss,and Tel.No. Designer's Name,Address and Tel.No.
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t e 0 A1Sr �u,//i vah Ehy�r r� �-7�. 64* 4ta f a7a �f
3 2�� ^" Lam_ nark r �q
Type of Building:
y Dwelling No. of Bedrooms Lot Size /9� sq.ft. Garbage Grinder( Af O
Other Typeo;Bu �ilding No.of Persons Showers( ) Cafeteria( )
- Other Fixtures x
". Design Flow µ ,. . 30 gallons per day. Calculated daily flow T44, gallons.
s Plan Date act Af J,aA�,r�• ) Number of sheets Revision Date Nt4
' Size'-of Septic Tank • /J�Q��a y/t7i Type of S.A.S. /eldch)'i4 C�WiA&r
Desc iplio`n of SOB 0�" �i�Od'1►I�yr4�I9i f_ G -/7 +hr�rJ Cixt r5�. .Se nz zs yr yl,,
Ontivl) ''r•r.w.. 44kkt jU r .6& d b o s ye•/tlty 10e'1C _Whuo
A-P I P" 'CJ /. • U C 01-01 t rh e'uet i is -W 774 /OG/G/Y 90 -16o, C.A 5,/r�,j .6rA -i �/tnti s,k' S4tL ?J, 1l�
P /0o-/44C3 1!l/ cmw Sai�6�'6"yr�/�u /D� -/3.�"(`�{ yr/i,at, Ajn• C'axsr.3� _tn.G io�.�GjA/;
Nature of Repai or Alterations(Answer when aPl�S1lica 'ee)
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 Certifi-
cate of Compliance has been issued byrthis Board of alt s �.
Sigizz ' Date Ct ^&
Application Approved by �1,./ _ Date // ✓-0 L
Application Disapproved f r the following reasons
——Permit No. ri a Ll— —_——— ��
_— Date Issued— / /= / ' —-
-- - ----
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 rW V C 1 A/ l f �
at S� . _c_if V •l {'_ has been constructed in accordance
with the provisions o itle 5 and the for Disposal System Construction Permit No.ono t-/'Aa dated //-1_O q
Installer Designer I /
The issuance of this a 't/shall of be construed as a guarantee that the system will function desijned._
Date Inspectory_;K�f li 7A_ .. V��-
----� /-- —-------------------------=— -----
No. uo `I S-v 2- Fee I k) '
THE COh`,!.J1ONWEALT1H OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
mioog_aY.�&pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair(1/)Upgrade.(_)Abandon( )
System located at J,;. 2) cu_7 ,<f• Ox ft-r y e•/1
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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 permi
Date: 11
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f '0 �/ Approved by � _ 1.
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10,
`= TOWN OF BARNSTABLE
LOCATION /-23 So- ®.s SEWAGE#.
VILLAGE ASSESSOR'S MAP&PARCELj /PJ
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INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY Sb®
LEACHING FACILITY:(type) A SZ.o Jh�J. (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: ® 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
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U.S. Postal Se M-M,M
CERTIFIEQj MQIMr.I.R6ECEIPT
(Dd+mestic,Mail�Only;No Insurance Coverage,Prov_i.
IF,o�•delivery,information,visit our web`sitii aat www.usps.corn®
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PLED INSPECTION 1 I ��Z
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
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DEPARTMENT OF ENVIRONMENTAL PROTECTION
MAP
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LOT
TITLE 5
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 123 Bay Street
Osterville, MA 02655
Owner's Name: Estate of K Virginia Adams
Owner's Address:
Date of Inspection: April 7, 2004
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O. Box 49
Osterville,MA 02655-0049
Telephone Number: 508 862-9400
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CERTIFICATION STATEMENT t
I certify that I have personally inspected the sewage disposal system at this address and that the ijafrmatiorportic
below is true,accurate and complete as of the time of the inspection. The inspection was performsI based AmyCO
training and experience in the proper function and maintenance of on site sewage disposal systems I am DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sy te :
Passes D
Conditionally Passes NJ rCD—
Needs Further Evaluation by the Local Approving Au ority W M
✓ Fail
Inspector's Signature: Date: April 9, 2004
The system inspector shall subm a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
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OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 123 Bay Street
Osterville, MA
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the "Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined", please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,-not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
ND explain:
2
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Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 123 Bay Street
Osterville, AM
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and'SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
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Page 4 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 123 Bay Street
Osterville, MA
Owner: Estate ofK. Virginia Adams
Date of Inspection: April 7, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ ✓ Static liquid level in the distribution box above outlet invert due to.an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a.private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
NOTE: Single cesspools automatically fail in the Town of Barnstable.
Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed-under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
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Page 5 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 123 Bay Street
Osterville, MA
Owner: Estate of Virginia Adams
Date of Inspection: April 7, 2004
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner, occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection ?
✓ Were as built plans of the system obtained and examined?.(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ _ Were all system components, excluding the SAS, located on site?
✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
✓ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes No
✓ Existing information. For example, a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
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Page 6 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 123 Bay Street
Osterville, AM
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system (yes or no): n/a ' [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system (yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Unavailable
Was system pumped as part of the inspection(yes or no): No
If yes, volume pumped: gallons-- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
✓(2) Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components, date installed(if known)and source of information:
Unknown-no information available
Were sewage odors detected when arriving at the site(yes or no): No
6
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Page 7 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 123 Bay Street
Osterville, MA
Owner: Estate of K. Virginia Adams
Date of Inspection: April 7, 2004
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron 40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass Polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert, evidence of leakage,etc.):
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE_ DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 123 Bay Street
Osterville, AM
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no).-
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: None (if present must be opened)(locate on site plan)
j Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets`equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
8
• Page 9 of l l
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 123 Bay Street
Osterville, M4
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
SOIL ABSORPTION SYSTEM(SAS): None (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits, number:
leaching chambers, number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,
etc.):
CESSPOOLS: ✓ (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 2 single cesspools
Depth -top of liquid to inlet invert: 2'
Depth of solids layer: 0"
Depth of scum layer: 2"
Dimensions of cesspool: S'W x S'T x 8' bottom to grade
Materials of construction: Cesspool block
Indication of groundwater inflow(yes or no): None
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
One single cesspool serves 2 bathrooms. The cesspool in the front yard receives kitchen waste and was not dug up Single
cesspools automatically fail in the Town of Barnstable.
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
9
31
Page 10 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 123 Bay Street
Osterville, MA
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
a �
s
From
10
r
Page 1 1 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 123 Bay Street
Osterville, AM
Owner: Estate of K Virginia Adams
Date of Inspection: April 7, 2004
SFFE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 15 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: Topographic and water contours
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using the Barnstable topographic map and water contours map the maps are showing approximately 15'+/- to ground water
at this site.
This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a
warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,
either expressed, written or implied, relating to the system, the inspection andlor this report.
11
_ TOWN OF BARNSTABLE
s,LOCATION 103 sT,
VILLAGE 0 MrV i ASSESSOR'S MAP & LOT
s
INSTALLER'S NAME&PHONE NO. /
f SEPTIC TANK CAPACITY 5,•,�1� C2,SSY�W
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS J
BUILDER OR OWNER dl k ✓Irgl^,4 A (?AM.I
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 leachin facility) Feet
Furnished by cton J • �f1r�
S
91)
V
I
yv- 0 ,,66
BA Y S TREET:.
�\ DESIGN DATA
Single Family- 3 Bedroorn,Exist. _� ` ." ' ••.:
i Qf No Garbage Grinder t0 •.o
I o Daily Flow: I10 x 3 = 330 gpd Cf:/S`
M1re.) tv111J.) \ SepticTonk:330 gpd x 200%=660gpd i a;
—— — — --s Use a 1500 Gallon Septic Tank. 2 B '•' J
lZ
LEACHING AREA
330
9Pd/0.74=446 s.f.Required
Sidewatl:2(12'+36
-
)2= 192 s.f. n- .•�`
to -� LOT AE RA i Bottom Area:12'x 36'= 432s.f.
O O _� \• E`,r� \ o•4 b A e r 624 s.f.Total Provided: rr '" a Do: .\1 •'
' .� • .
J A LEACHING CHAMBER DESIGN
/ a �\�sT q All Pipes to be Schedule 40 PVC. Use "� '�•�
o �y. \ ✓', -500 Gallon Leaching Chambers in !� 111 •e:
1
' 3 _ 12'x 36'Washed Stone Field as Shown. '
LOCO_S PLAN
f Z !x lS-r„ 3 13f�Df10oM �', _ / NOTES Scale: 1'1=2000,
I w/F Dwc�+-1No—
td I I L Water Supply For This Lot is Municipal Water. ASSeSSOfS Map 117
ox C
X
� 'SEOTI4 2:Location of Utilities Shown on This Plan Are Approx. POIC@I 149
Q 'T'A.NK \ At Least 72 Hours Prior to Any Excavation For This
I I Project The Contractor Shall Make The Required Zoning '. RC
Notification to DIG SAFE-1-888-344-7233.
1
f 3.The Contractor is Required to Secure.Appropriate Setbacks:Frde 1 01
Co x I ST ua^c.H ' +n, caAwu spACE To New~ Permits From Town Agencies For Construction 0'
Side I
\ P+T �• iz¢a�un�o Ex�sr.wAsre� Defined by This Plan. '. R@01'
t / �\ S�Pric SYSTEM. ; 4.Install Risers as Required to Within 12"of Finished Groundwater Overlay AP&
/ Grade.
J, pp GP
5.411 Structures Buried Four Feet (4) or More or
Subject.to Vehicular to beH-20Loading. o T:H. ELev. \�•d
t \ / ExlsT. LEAc►1 P+�sTc 8E 2O 6.Septic System tobe Installed in Accordance With o uos>*n/o+zaAN+c
o PLAN VIEW: Pun.+Pta �+l_LEo wITN 310 CMR 15.00 Latest Revision And The Town of
CL_S.AN NAkT6-RIP.1_ Barnstable Board of Health Regulations. a 6RowN COARSE SA0d0
ToPo�cu�PHtc ttvFoeZnne+,Tlon! Scale : 1 it= 301 7. All Piping tobe Sch.40 PVC. 17'
TAKG.t4 FROM T.O.+3- Cr=S 81 VE1_+sH DRN G'oARSE
<=0R PROPER-C'Y �-+NE INt='ORMATION SEE St�ND` LOYR`S/L
MAP, PLAN SY r_DwAmo KEL\-esY DATED !
BC 1BRN'15H YLL. COURSE
1 Finish SAND IoYR.G/G .
Grad. - So.. .0 1 LT. YEL'1 Sb1 SRN.G.pARst - ..
„ 3AND VOYR (a/'/
� - q
a�F lot 11r,,, CZ STR'G•. ORN COAR^aE
F.G. 20:0 m si Fabric,` Compacted FIII I OQd SAND 7,5 YR S/a
t S
Crawl F.G.18.0
iv _ • YEL%SH REO ARSQ
Space Pea Stone SANG 5 YR-4 le
tOB
,€ � � � 1..T:`(Et..:15W CiRIV.G.OARSt
18.0 16.0 in 121' CN 9AN0 IOYR (,/y
- _ —
1500 Gallon Top E1.17.0 'v chamber
Leaching aia'-I v2"Gwbi. \V p e,Roul.+q wATGR
17.4 Septic Tank 17.2
N
BOt.EI.. 14.0 � � � Washed [•3Y: SL1l.L\VAN LNG-INEEC21NC-lNG
16.4 16.2 6.2' �. r a.-io' I O c.T, a e,200
12•_Q..
Bedding as Bot. T.H. El. 7.8
Per.Title 5 No Groundwater ! OF
CROOT SS SEALE
CTSECTION OF CHAMBER.
DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM PETER
Not to Scale SUIXIVAN
W.29733 ;
Depth of Inlet Tee Below Flow Line:10 Min.
fix•
Depth of.Outlet Tee Below Flow Line:14"M in. T�
With Gas Baffle.
1 SEPTIC SYSTEM UPGRADE
CARRIE 8t HUNTER LUKE
123 BAY STREET
OSTERVILLE , MASS.
SCALE: AS SHOWN DATE: OCT 29, 2004
i SULLIVAN ENGINEERING INC.
OSTERVILLE , MASS.
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