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0040 DAVID STREET - Health (2)
40 David Street, Osterville AST BAY COMPANY 7 a { t k, O OT F BARNSTABLE, LOCATION L10 V�6. 1 SEWAGE# VILLAGE 0- GN,ILL ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY C/Uti LEACHING.FACILITY:(type) (size) NO.OF BEDROOMS nn OWNER r/Jy 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 1/I.t�Pu 1 ion 6A AFro n� Q O . A Q O �e 3 y 3 9L 3y y 38 ag M COMMONWEALTH OF MASSACHUSETTS; EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS (� DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 FORM-NOT FOR VOLUNTARY ASSESSMENTS OFFICIAL INSPECTIONO SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 40 David Street Osterville.-MA 02655 Owner's Name: Virginia Fav Owner's Address: Date of Inspection: May 28, 2008 Name of Inspector: (Please Print) James M. Ford �J Company Name: James M. Ford y ' Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 r\) Telephone Number: (SM) 862-9400 `o wZ CERTIFICATION STATEMENT = rr^ I certify that I have personally inspected the sewage disposal system at this address and that the in ormatio?&R portO below is true,accurate and complete as of the time of the inspection. The inspection was perform d basedrpA my r— . training and experience in the proper function and maintenance of on site sewage disposal system lam a bEP"' approved system inspector pursuant to Section'15.340 of Title 5(310 CMR 15.000). The system: p Passes Con it'onally Passes. lee s urther Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: June 11, 2008 The system inspector shall subm copy of thi 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 Cornments ****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 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 David Street Osterville. MA Owner's Name: Virginia Fay Date of Inspection: May 28, 2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any infonnation 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 systern 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 David Street Osterville, MA Owner's Name: Virginia Fay Date of Inspection: May 28, 2008 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 15.3.03(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 detennine 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 forn. 3. Other: s 3 Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 40 David Street Osterville, MA Owner's Name: Vir ink is Fay Date of Inspection: May 28, 2008 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 'h 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 I 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.] No (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 detennine what will be necessary to correct the failure. E. CLarge 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 II 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. 4 a Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM'INSPECTION FORM PART B CHECKLIST 4 Property Address: 40 David Street 9 Osterville, MA Owner's Name: Virginia Fay Date of Inspection: May 28, 2008 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ 'Pumping infonnation 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 ofwater been introduced to the system recently or as part of this inspection? t ✓ 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 backup Was the site inspected for signs of break out ✓. Were all system components,excluding the SAS,located on site? n ✓ _ 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: ✓ Detennined 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)]: 5 Page 6 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 40 David Street Osterville, MA Owner's Name: Virginia Fay Date of Inspection: May 28, 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n1a [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 infonnation: Unknown 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 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 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . 'SYSTEM INFORMATION (continued)' Property Address: 40 David Street Osterville . ' MA Owners Name: Virginia Fay Date of Inspection: v Ma 28 , 008 ,. BUILDING SEWER(locat e on site plan) lap , p ) 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: ✓ (locate on site plan): Depth below grade: 10„ Material of construction: ✓ concrete metal fiberglass _polyethylerie _other(explain) If tank is metal list age: : Is age confinned by a Certificate of Compliance(yes or no): (attach a copy of . certificate) Dimensions: 1000 gal. - Sludge depth: 2" a Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle:: ` 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage GREASE TRAP:, None (locate on site plan) Depth below grade: f .' 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:,, Coiivnents (on pumping reconunendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,.evidence of leakage.,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 40 David Street Osterville, MA Owner's Name: Virginia Fay Date of Inspection: May 28: 2008 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grader Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no):.._. Alann level: Alann in working order_(yes'or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): D ISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Conunents(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.): The D-box was clean. No solids were present. 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 I . Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 David Street Osterville. MA Owner's Name: Virginia Fay Date of Inspection: May 28,2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-Pits leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,nwnber, 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.): The leach Pits were dry. There did not appear to be any si ns of failure A camera was used for the inspection CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 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(yes or no): Comments (note condition of soil,signs'of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: r Depth of solids: . Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 David Street Osterville. MA Owner's Name: Virg inid Fa Date of Inspection: May 28, 2008 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. } t 6AA Fro sr�P 0 0 O 1-7 3 a a a8` a a 3 ace �y 10 4 Page 11 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 40 David Street Osterville, MA Owner's Name: Virizinia Fay Date of Inspection: May 28, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- 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: Topo&lyphic avid water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximated 30'+/ to Qroundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed 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 septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 'T owii of Thai mtcible Regulatory Set-vices MRNSMBLE, : Thomas F. Geiler, Director MA&& Public Health Division ATEa may a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit'.. If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTICIDisclaimer Private Septic Inspections.DOC i ;r. ('FRTTFT�'D` SEPTIG SYSTEM REPORT 4 I .47-DAVID ST . OSTERVILLE, MA MAP 141 PARCEL 078 LOT 27 PREPARED FOR MR. & MRS . CURTIS 'R. BLANCHARD -T-DAVID ST . �Ck / OSTERVILLE, MA 02655 BUYER 1996 NONE AT THIS TIME PREPARED BY HILLIARD HILLER P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 r commonweatth of Massachusetts_ Executive Office of Environmental Affairs Department of Environmental Protection Trudy Core WNIWn.F..Wald Gawr r David B.Struhs AMM Paul C,siluocl U.GWMM SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART?: CERTIFICATION Address of Owner property Adak 7 / (If different) Date of Inspection: 6,110;;G Flame"oflnsPectoc Company Nam- A ddraw and Telephone Number.. �O p ax a 0 G��r/lE2U/AGE � H� oai C32 CERTIFICATION STATEMENT I cart*that_I.have.personally inspected the,sewage disposal system at this address and that the information reported below is true,accurate . g and,experience in the proper function and and complete as of the time:of.inspection- The inspection was performed based on my trainin maiatenaaee of on-one sewage disposal_systems. .The.system: 1L Pis Conditionally Passes _ Needs.Further- By the Local Approving Authority Fails l — Date:11 Or � bwpectoes:signatut�e:: The System Inspector shall submit a copy of this-inspec`aon report to the Approving Authority within,thirty(30)days of compl*Liag this. v<a shared system.this has a-design, flow of 10.000 gpd or greater,the inspector and.the system.owner shall submit.the �e�OII Tithe m of.Environmental Protection. rpoet �. .regional olfiee of-the Department- authority. The.Original shoa1d be-sent to the.system.owner and copies-sent to the buyer, if'applicable and the approving' my INBPWI•ION:SUMMARY: - Ch@d&h,C,or`Dc Al. SYjTEM PASSES:. have�t fouad.aay information which indicates.that.the system violates any of.the failure citeria as.defined.in. 5.310.CMR 1303. Any��,�� na.evaluated-are,indicated below. BI SYBTEW CONDMONALLYPASSES-.: t need.to be replaced or repaired. The.system.-up(a-completioa of.:the.,replacement,or repair,.passes One-or more.system..aomPonea , If"not determined;.explaia:why notl ,M no,or, �naa(Y;_N.arND)...Describe,basis,e£.datermiaatioa 3a:all.iastainfilt on-or acfltranosr,ortaair failu�m `, The�_�k i :mom.cracked-stHattrally-unsou d,.Shows:substantial iafiltran inn ems.septa tank is replaced with:a sonformtag septic taa)t as approved immanent.'The sy�cem well pecuon if the by the:Boaid:.cflisalth. ' L - (revised 11103M5)' pee WlttesrStroet • Boston .MaaaachussNs02106: • FAX.(617).556-1049 a Telephone(61T)21i2-3500 Pnnia wraeeVCWPape, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 O/Jv�O ST �Tx2 viG L2 Owner. Iti/iu2 G!/,e1-jS Dale of Inspealion: 'Chock.if the following have been done: ✓Pumping information was requested of the owner, occupant, and Board.of Health. Now 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. ,4 As built plans have been obtained and examined. Note if they are not available with NIA. ,i facility or dwelling was inspected for signs of sewage back-up. 1,,/The system does not receive non-sanitary or industrial waste flow P/The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System. have been located on the site. �_-I septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or toss,material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The,rise and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive_methods. The facility owner(and.occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. .(revised 11/03/95) 4; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART G SYSTEM INFORMATION Property Address: 7 OfI v/,0 S T Owner. !h/i7 G G/1 T1 SS R. /3Gll.t/Gf`i??d Date of Inspection FLOW CONDITIONS RZSIDENTIAI: Design i1ow:gallons Number of bedrooms: Y Number of eurrent residents: Garbage grinder(yes or no): Laundry cuunected to system(,yes or no):�/—/ Seasonal use(yes or no): /9 IVY 53 Water meter readings,if available: /y 7 7� /37 G/F G /99 Y- 7�, � � -83 last date of oecupancy: !'l ky4-TT1'y C0MMERCIAL/INDUSTRIAI. Type of establishment: Design flow:, p1lonslday Grease trap present: (yes or no)_ Industrial"Waste Holding Tank present: (yes or no)— Non-sanitary paste discharged to the Title 5 systems(yes or no)_, Water meter.readings,if available: Last date of ooenpancy: OTHER(DeKnbe) Last date of ooarpancy: GENERAL',INFORMATION PUMPING RECORDS and source of information: Sdfr`i,�2 oe �o �,rio f�,�'�//U,/S ' . :r-U 7'`fsr'T, ✓L� �ili�ll Sys pimped as part of inspection: (yes or,no)�� �N�� G✓AS (sO/.vG Tv /l/j y� �GG.�,i��'O If yes,yohrme pumped: Reason for pumping TYPE OF SYSTEM n Septic taalddistrbcrtion box/soil absorption system Sire oasspool taw cesspool Privy Shared"systam(Yes or no) (if yes,attach previous inspection records;:if any) Other(asplain) APPROXIMATE AGE of all.components,date installed(if known)and source of information: /2 Serwap odors detected when arriving av the site:,(yes or no)-1—VO <revised'11/03/95) 6 M : "- ':a a .. - �. .:• ;._ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 7 DAI//,Q ST Osr�,Z iILG(' Owner Date of Inspection SEPTIC TANK !/ (locate on site plan) Depth below grads: /� Material of .ion:i a _metal_FRP _other(explain) Dimraoons: S o 8" O J 7 -,410 Sbsdge depth: IS' Distance from top of sludge to bottom of outlet tee or baffle: 13 Scum thulmees: T' Distance from top of scum to top of outlet tee or baffle: 41 Distance from bottom of scum to bottom of outlet tee or baffle: /S 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.) 1"A//k A.y0 �r/lG�T T cr�/C"C� lsr-bI7 T hZit�L c iiPS �i c/tasS— cSiG?7U�/AL X19A 6-' />A/ r&A irr,.cr /io Tzz Go OF Lf A16. GREASE TRAP. (locate on site plan Depth.below grade: ,w Material of construction:_concrete_metal_FRP --other(explain) Dimensions: Scum thiejmssa: ' Distance from top of sarm to.top of outlet tee or baffle: Distance f o=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, etc.) (revised 11/03'/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Andress: 5 i/ s Owner. Idi/,7 G v/L i/mac /� f3G�.vG irit2lJ Dale of Inspeotlon: TIGHT OR HOLDING TANK1 (locate on site plan) Depth below grede: Material of mnsw=tion: concrete_metal_FRP_other(explain) Dimensions: Cspacit3r ¢allons Design flow: ¢allons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert.^ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) o —Al PUMP CHAMBER:_ (locate an rite plan) Pmnps in working asder.(yes or no) Ccmments: (note osndition of pump chamber,condition of pumps and appurtenances, etc.) (revised 11/03/95) 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM_INFORMATION (continued) Property Addreiew 7 zwe-lo SJ ©ST.�.tusu� Owner. h1.y G U.Q ri 5 /Q. j3G�Y G �I2 J Date of Inspeotion: SOIL ABSORPTION SYSTEM (SAS):_jZ Gosh&as she plan,if possible;excavation not required; but may.be approximated by non-intrusive methods) If mt determined to be present, explain: Type lnchiag pats,number: leaching chambers,number:_ lnehing galleries,number; leaching tranches,number,length' leaching fields,number,dimensions: o"rflow cesspool,number: Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation etc.) Ae-D /1S 1"Ai L,i LidT /yGdd"A10 �'/' .CI�o �' > o �c�vly Oy /I .ai7:5 CESSPOOLS: (locate on.site pka) Number and configuration Depth-top of liquid.to inlet invert: Depth of solids layer Depth of scum layer: ' Dimensions of cesspools Matseitls of oanstavction: Indite of groundwater: inflow(cesspool must be pumped as part of inspection) • Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) - k PIWY• Qaeate• ate plan) J Dimensions: Depth of acids:' Ca®ments:-(note condition of soiil,:signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Erevised 11103/",); 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address 7 ZW exl o S% Owner. A7 .7 Date of Inspection: G j/�/y S R' �G/}riGit20 q SEZTCH OF SEWAGE DISPOSAL SYSTEM: inC &ties to at least two permanent references.landmarka or benchmarks, hate all wells within 100' o I � DEPTH TO GROUNDWATER. ` t Depth to astirod of drtaminaticm or apprmdmation: Q.9llliS/'?s'dGi£ C/S S"i` Z 0'6 Th`7; G2vAi Ty Pd,C r9 T`" G(/AT,64 LMI-X DRi9W141G (revised 11/03/95') 9 Vim.'Z................... THE COMMONWEALTH OF MASSACHUSETTS BOARD? QF HEAL H 4/1 -07 .........OF..... .. ...... . ....... ............11�............. Appliration for Uispaaal Works Tonotrurtion Frrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst at ................... ... .. ........... .................. ...................... --------------A.................. Lo Addr r_Lot NA.,, .... .. .. ..... f4 A-dress r Address Type of Buildilig. Size Lot............................Sq. feet aDwelling X No. of Be oms...........6/ .......................Expansion Attic Garbage Grinder ( 04 Other—Type of Building ............................ No. of persons............................. Showers Cafeteria ( Otherfixtures .......................................................................................Design Flow--------------- --.- --------- gallons per person per day. Total daily Septic Tank Liquid flow...... J-0 - - _- Liquid capacity/.....01;allons Length................ Width................ Diameter...-___.____-__- Depth........._..._.. Disposal Trench—No..........._ Widt1j............. a en��*h ;,�:�A.Ao I leaching area....................sq. f t. 0� e ot > �DAepthiVeo e ............... Seepage Pit No....... ........ ian1eter.//.-_._? Ig area..................sq. f t. (j�D Dosing tank Other Distribution box Performed Percolation Test Results ..... .......... Date... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to groun �r........................ �wate Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.............._..._____. .......................... ..................... ..... -------.. ............................... ift 0 'Description of Soil........ ------ ..... ..................%3.4... ..... ........................................ ........................................................................................................................................................................................................ 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 * sued he o ealth. Signed.. ...... ...qrl& ------- I ate Application Approved By........ ...... . . ......... ... 7.3 Application Disapproved for the following reasons: --------- ............................. ..........................................................Da.t.e................... .... .. ......................................................................................................................................................... ......... .................................. d Date Permit No....................... . Issued........ Z- . -------- e No.. .C. .�.°... Fes$.' .._.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HEALTH 77 ............................ Appliraiion for Disposal Works Tonstruriion Punfit Applicati•an is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sy..... at ...... .. ?.�..!�'.... /l' � _ .� --••-•-- . 10 Z .L ocali n•Address. . Add... / Ji' _ �r^_ .... /.rv'G.6& ��-•- o 4T �/� Owner Address W Installer Address U Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms............. ' ........................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -------------------------------- - W DesignFlow................ _ gallons per person per day. Total daily flow._... - allons. g P P P Y Y r g WSeptic Tank j Liquid capacity/___..._gallons Length--------------_ Width-----------_---- Diameter-__..._-___-___- Depth................ x Disposal Trench No_ _________ _________ Width_., t�tl.L�re th�y � moo, l leaching .......sq. ft. Seepage Pit No.......... r-_... Diameter./--_ Depth be ow ' et_______ otal leach' g area_._._..___._______sq. ft. Z Other Distribution box ({ Dosing tank � Percolation Test Results Performed by .......... Date_. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------- -- 1" -- O Description of Soil. a ... --- ��� `..... U ------------------'�"`-.4..-...r..---:-•- `--'f--`-_-• -+„+f ----:""- --'••-- '"-a"------ -.5•".�f':.4-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 'ssued y he o cl o health. ,- Signed---• -- ... . - -"�'�-�' --------- -.---------.. -•-�/� � _....._ ate Application Approved BY----`".- w ; Date Application Disapproved for the following reasons------------------------------- .............••--•----•....-------•--••-••------•-•---•--------•--•--•-•----••••----•._......_•--•••--••-------•.---•-••••-•••----•---••-•-•-•---------••-••-•---..................................... Date PermitNo......................................................... Issued-------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ...........OF....... � .. " ................ {� " .-.. wrtif iratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (a )`or Repaired ( ) by........ ....................... + �° j / fnstall ............................ at.. �f- '---------•--------- - •----•----------•-•---------- has been installed in accordance with the provisions of Article XI . f The-.State Sanitary Code, as escribed in the application for Disposal Works Construction Permit No. dated---- . ___-............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE OPI TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ��� � 7 - . — �4- DATE................................................................................ Inspector.......��: .....-. -•-•------.---.---•-•--•--------------- THE COMMONWEALTH OF MASSACHUSETTS ,r BOARD OFFALTH ' ` , ...................OF..... -----•--- FEE.. Disposal Vorkg Tonstrur � nmii 4,- Permissionis. hereby granted.................................................................`...................................................................... _.... to Construct ( /or,-Repair( ) an J4dlyidual Sewage Di p'osal System at No..... I Street PP „rmit No...... ,_ ated•-- xp' ......... as shown on the application for Disposal Works Construction � P r Health DATE...... ... ............ ............ . d ,,Board of t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS BARNSTABLE SURVEY CONSULTANTS, INC. MEMBERSHIP IN: MASS. SOCIETY OF > SURVEYORS AND ENGINEERS PROFESSIONAL ENGINEERS& LAND SURVEYORS POST OFFICE BOX 734 4 1 1 M A I N S T R E E T CAPE COD SOCIETY WEST YARMOUTH, MASS, 02673 PROFESSIONAL ENGINEERS TELEPHONE: 775-7719 & LAND SURVEYORS August 221, 1973 Mr. Gerald Anderson 5 New Hamshire Avenue West Yarmouth, Mass. Re: Lot on David Street Osterville, Mass. Dear Mr. Anderson: On August 17, 19731 we inspected a test hole on the above referenced lot, the results were as follows: 011 - 611 Loam & Subsoil 611 - 361, Clean Medium Sand 3611 -12011 Clean fine sand mixed with stone No water encountered These results indicate an excellent percolation. If we can be of further assistance, please do not hesitate to contact us. Very truly yours, William G. WeIller LAND COURT PROPERTY RIGHT OF WAY SOUND'rNGS FILL PERMITS PIER PERMITS - • TOPOGRAPHY • SUBDIVISION CONSTRUCTIONS • ` SANITARY -LANDFILL �, . ..,,s r;- ,, - ,, ati'1 9 - „v!•.> e. r t- R,. I, :tr ' -`r,. ♦ ^.- } y:"�.+Y d ���;ayy rya •` ''"l ± ,�'+''� -� ,•1`la,,,.v�ig ,. l4,'.+ ,a+�s_r i'.4 y' Z���. ft-'.*I' • '�k• � 'y `Y.l .r y;+t�r� '�4.i , .,:�''rt �'!`. 1.0 - - i F S'r 14. • . _1 i5 t: t,r. ."er+.:.,r .a ,-�ts.•• a tl E ,-r�i.Y'i+ ,-, r, ..'I ,,t '�..�y;l iy ., y ! P,I •J•I+ 1t - r , ,t ;�_Rn ' 'R 1 a' i .,µ � 'r ht•• ti > ,., #+� .#,'•. ; .H� s.S, x f. 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