Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0308 EEL RIVER ROAD - Health (2)
308,pool Eel River,.Road-a f - osterville P n . A 116 '013 w„ N i i ii II a � No. ?�& � Fee$ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Moozat *pm'em Construction Permit Application for a Permit to Construct( )Repair(X 4 Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 308 E e 1 River Road Owner's Name,Address and Tel.No. James Wood Osterville,Mass. 02655 356 Bridge Street Assessor's Map/Parcel //,3-- 015 O s t e r v i l l e ,Mass . 02655 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Desi ner's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 H J.P.Macomber & Son Inc . J.) .Macomber & Son Inc Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass. 02632 Type of Building: Dwelling X No.of Bedrooms 4-1r' Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow . 330 gallons per day. Calculated daily flow 3 x 110 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Installing 1-15 0 0 gallon tank 1—distribution 1-500 gallon chamber for tTFe- pool house toilet . ep acing line trom the house to the existing septic tank, instaiiing one distribution box and new ines rom the tank to the box an Date last inspected: the eXisting pit. Raising covers on box & pit . 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 b this Bo o fealtV Signedr Date Application Approved e Date r Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (X X)Upgraded( ) Abandoned( )by J.13.Macomber x. Son Inc. at -`'`)8 ; e 1 1':1 v e r Road ��S t e> v i 11 E , $a a s. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No t •� dated . Installer j . P Hacomber Sore Inc . Designer J. P f,[ac.omber & Son Isic The issuance of this permit shall pot bb cot>sttrued as a guarantee that the systetn will function ass designed. Date Inspector ,m. 1 f t, —E�—� ...,.——r_P` ---------------------------- -- No. f ...fir Fee �' 5').i)i_3 d Commonwealth of Massachusetts ► Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville ✓ Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. Ins ector Information /'/�}d' / When filling out p 51#- !'T! 7 7 forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-28-2020 to ors Signature Date The system inspector shall submit 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address owner Simons information is Owner's Name required for Osteryllle Ma 10-28-2020 every page. CityTrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This inspection is for the pool house and at time of inspection this system met all minimum passing requirements. This report can not predict the future performance under the same or increased usage.This system was installed in 1999. 2) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5insp.dcc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Ostervllle Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N FIND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,1� Title 5 Official Inspection Form 4; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Ostervllle Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes ' No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® 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 1 of a public water supply 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form ,} Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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? i ❑ ® 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ 2 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(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 '�, Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 1 Number of bedrooms (actual): 1 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 110 Description: According to the previous inspection report this system consists of a 1500 gallon septic tank a distribution box and 1 500 gallon chamber with stone. There were limited records on this property at the Board of Health at time of inspection Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this.report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2018 was 728.7 gpd and 2019 was 745 gpd, this is for the entire property including Main house,pool house ,irrigation, pool ,and fish pond. Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �n l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osteryllle Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): J Approximate age of all components, date installed (if known) and source of information: 1999 off previous inspection report. (State recommends pumping every 2-3 yrs for maintenance) Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 0'40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 1 .. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts r= I9 Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L � 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 gallon per previous insp Dimensions: report 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.): Tank was functioning properly at time of inspection with no signs of failure or back up. If tank has not been pumped in the previous 3 yrs I recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 f Commonwealth of Massachusetts �P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): i Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (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 per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State. Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑. Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): d-box was functioning properly at time of inspection with no solid carry over or signs of back up t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 1 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House ' Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding;damp soil, condition of vegetation, etc.): 12. Cesspools (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 ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. CitylTown -State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �. ►p Title 5 Official Inspection Form 1° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / 308 Eel River Rd Pool House Property Address Owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 \ cam, Commonwealth of Massachusetts �. Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form Not for Voluntary Assessments v 308 Eel River Rd Pool House Property Address owner Simons information is Owner's Name required for Osterville Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) , 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system.design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: attached previous inspection report page 10 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 , Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 308 Eel River Rd Pool House Property Address Owner Simons information is Owners Name required for Ostervllle Ma 10-28-2020 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A- m /-�-C(L� DATA Page I I of I 1 _ OFFICIAL INSPECTION FORM — NO"1' ,SUBSURFACE' SFW,--,C;: 'DISPOSA:f.,'SYS'1•"1 �1�I!NSPEC ION FORM SYSTEM T �I'i�I?��l.l'1,ION (Cot!tinucd) Property Address, 308. £e—ei /?lverL ?vaa -ZJ ST TTc,+ Owner: grae,3 01 c D] IC of laspCct!on: 9/ti 3i L 3 SITE FX.A;t Siope S'vr arC Water Shallovt NvOs Estirnatcd depth to ground wn!,r -- indical'(check):!!I richods used tri.czc l!lific the 1:;Lh rot:nd 15';it�r t:Ie1'3Uol}i r,n, I IT.C'!7! --!mil ,.« _ !t li1C�)"';J •J 'a "'' r �'' ' f' t - i. :I ttY tJ,f3:f}J.'attr.GY•r+;:N•Cy�: /- cr S �YJ G!-•,c:' S:'t!.2�'JairL jf'i� c'i�.ii! s!1''.a I!Ji:'- !I!i.� �I`�I I.C:4.1 S ...� _ .�.. .._..._... lo•_ ! or HC-l! h t l:!in: :! � �'ii 11!)Gh: C'.CB 4'i:a': ,..:1I!:fs•� t _'I!�J+�::1':I; i' l+ rl!' Addis,:! �USGS i♦at!f;,,:SC-CYL`.,I�.:i;t:_l� :: -f 1:-rJ;ilrl e ?:!L_. ,j�I.r'r!'. I'•',i. %1 S. You must _dcsscrib hOW Vou esta.bl—ishc.d the -- •T��i`sa't%c�r eJ.cv.s—ii rn. : ( ir l2'` 1Oi !,, —' .:( G 7L, n < n - ----- -- ._._f_ s 3 _.f CC r?1_ilt-94r.e C. h Croj (1',l to::; ;u,trncM 1.8 ft ocr Frimp'. f.iC:ft/}d i :ft rU:C, !iC v.fUr it rn vosta i c v t'C' !CG th^ Vrit:Q( j, ;(ttu. ' ' 1.1 ;t .., t.c r+1t ,�;cd g tScpd&atcr !ab!c is ra ' • i Page 10 of OFFICIAL INSPECTION FORM — NOT I'O)? ti'UX�I►i�'1'.•�Z'� ASSZ;SS�tH'.�'f'S ' SUDSURFA.CE S1?WM7"E 1:iIS!'05,1), 5 'S"1'4:!17 Iti'SPEC' ION FOIL- i }`ART C S`l'S'L (comirlwed) $ �..f i z..>. z l�o.�i• Pru}�trh'Address:30 ..r r Ok'Uef: ZQr ?S �rO0d' U'a(c of Inspection: I/,i 10 SVLETCH OF SEWAGE DISPOS:%I.. SY: 7TM Y'fJirh' ;i;ei;il L'I (Ise tC..P;�C C�15iei;�tj t:3l-in :S,!'iJrJ:r_,I;CS !C��i�`I!.,Sf 2'�TL' �Cr!'!?dliC(?t rifercncs"i'1:!�!?ld!'k5 - •: .�: :i: .6. .�.� �c_i. 4,�,.:.ii. .�ii!iC �. .;ii. �.ti P.ti� .�t'��rtj Cu,CI] illc tJJ1IU a1 . . Z• f i { 10 ` 1/6/99 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) { LJ o s e p h P.Macomber J r . , hereby certify that the application for disposal works construction permit signed by m 9/8/99e dated , concerning the property located at 308 Eel River Road Osterville,Mass . meets all ofthe following criteria: IF The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 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 feet of the proposed septic system JThere are no private wells within 150 feet of the proposed septic system J There is no increase in flow and/or change in use proposed f There are no variances requested or needed. +� The bottom of the proposed leaching facility will not be located less than five feet 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 feet of any vegetated wetlands, the bottom of the proposed leaching facility will noI be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) y B) G.W. Elevation'! +the MAX. High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED DATE: (Sketc oposed plan of system on back). q:health folder.cen r _ ,. . . ,. �ooG . . � , ---e �� i 0 i, ,I : $�;�,y i V\"I-./ SEWAGE INSPECTIONS LOCATION _ 308 Fe P Rive2 Road DATE 9123103 VILLAGE 0,3teaviiie. Nazi. ASSESSOR'S MAP & LOT 115-013 •INSPECTOR jozeph P. ftcomle2 aa. SEPTIC TANK CAPACITY 1000 ga eon s LEACHING FACILITY: (")2-LR- 1000',3 (sizc)3000 ga Uon- NO.OF BEDROOMS 4 BUILDER OR OWNER lamez Hood OWNER MAILING ADDRESS 'Same J �r i 4 0 0 � r �6� fi a� . _.�.•, Gam' ' r SEWAGE INSPECTIONS LOCATION 308 Eeei Rivet Road- `' DATE' '9/Z3/03 013fe22).ce ee, Na's3. ASSESSOR'S MAP & LOT -INSPbCTOR jozeph P. t7acomge z Ia.' SEPTIC TANK CAPACITY l500 qa eeon. I-Die.t2.igut.ion Sox. k LEACHING FACILITY: (type) 1-5 00 gaiteon ehamg jazC) 16. 5'X 9 3'X2' ---NO.OF BEDROOMS ° Poo e Kouze BUIL-DER`OR OWNER l.im Oood-3 ' t. OWNER MAILING. ADDRESS Same {� ;y - J 7. —TV Hose r TOWN OF B'ARNSTABLE LOCATION .1o1 iff'1 C1 re-v— �Zt) SEWAGE # VILL'AGEC9b-41.t.V ASSESSOR'S MAP & LOT �O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 �O LEACHING FACILITY: (type) DQ,Y W�1 J (size) Sock A)Zoy1 �l) NO;:OF BEDROOMS BUILDER OR OWNER PERMITDATE: lqci COMPLIANCE DATE: t Separation Distance Between the: alp 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 f`� x Y,: • .{� .. N,Y` fI h *' . � �-� .�� r� 4. . - r' :y i - ,,` _ .. . � ,a I 0ATE : 9123103 PROPERTY AOORESS:308 _Cee.2 Rivea Road ------------------ . 0.ste2vif2 rl - - ----------- - 02655 On the above date, I inspected the septic system-at the above address, Tr,,S system consists of the following: LE RECIVED 1. 1- 1500 ga eion eept.i.c tank, 2, 1-�ihta i�ut ion fox, 3. 1- 500 ga2Pon 2each.ing chain&e2. OCT 2 12003 Baseo on my inspection, I certify the following conditionsi TOWN OFBARNSTABLE 4. 7h.i.6 zy,3tem .ins ion the /2ooP house on.Py. HEALTH DEPT. 5. The 6y.6tem .ia .in /12opea wo2king ozdefc at f the p/te,3ent time. Cham9e z 6. -7he Zive hund/zed ga.2-2on4'.i6 /22eaent.2y day, 4 SIGNATUR game - -'- - P: _Macomber_ Jr .- -- Son, Inc . - cc(e'5s : l3Qx _tz - ------ Ce.nss?:YLLLP,-_ t)a _ _2Z632- 0066 rni$ CERTIFICATION OOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. T anks•Cesspools-l.eachllelds Pumped G Installed Town SR,4er Connections P 0 Boa 66 Centerville. MA 02632.0066 775.3338 775.6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE QFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 �" OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 308� fee P /Uve,,z Road eay.c e, a:s.6. Owner's Name:jame.6 Qood Owner's Address: Same Date of Inspection: Name of Inspector: (please print), I e12h I). Nacom ea aa. Company Name: a. l. Macomgea & Son Inc. Mailing Address: /3o z 6 6 Cente2vc2-ee Ma.3.3. 02632 Telephone Number: 508-775- 338 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ,� ' Date: P � The system inspector shall submit 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 r ' ****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 pag,, ? ofI 0?F1CLk! INSPECT1000 Ann .- .NOT FOR VOUTNTM YkSSESSMENTS S UBSURF CE SEWAGE DISPOSAL SYSTEM .INSYEC"PxC'N FO PART A CERTIFICATION ICATICN (contu, tad) Property Address; ��q '� ���1, tt 1 F, t Ro Od Date of Inspection; inspection Summary: Check A,B,C,D or E ;'AT fir'1A CtitllpliEe a1i 0'f CCIIQI! t3 "s A. 6r ILZEy us 1 have not found sny 4',formation which indicates that any Of It failtare criteria dc;acribed in 310 CNN, I$. 03 or A j 1 C CMR 15304 C&A ,any till Jt•z NOW not vskuyed LM tndlCm;d be1Jw. C,0niIntnt "' j1(� B, Systea.CoCidhWnaHy Qame?:. zj2Q. One or rnor,,- Sys-,rm components cS dcsc°ribcd Ln OF. Conditional PUY' at`Cs on "d W be oared or rCpa�CO. ,roe syslcm, upon Conlpleiioryof the replace rient or Apai.r, as approved by the: Board of Hcailh, will pass. Answer yes, no or not determined Y A,'ND Ln the tfi, for P fGi1014'ing-st.,tt''rntnts. dC "noi d+.ttrrnlP.°;u" ;?iC a3e /f/fJ(��Tlie septic tank is metal arid over oil gars (;l i" or LhC Se ti" df hCthei" 7 � � p W. Ct+. 0 not) 5 rr crarz"u 1 hns0r Pd "XnlJtS st,;bsonti91 lnliination or cQuadon or uwin NNule is t f1R1lf7CnL Sylas will pam ,nspenion if It ex,st:rg tank is repined wkh a comp,yirig septic lank as appmved bu the kS'i ud of HeahK n3em! septic link Mil pass hypection it it is st.LiCWf41ly 5U;lnd,riot leaking and it a Certificate of CampiiariCe inciicating t`af u e tank A less than ?U years id is available: ND explain: :t Observa(lGr! 01 5elVage backup GI brea) out or Slid 1 alatic wer level In Te dt$171bU1& WAR Gbroke G obancted pli, 0) 01 duc 10 a broken; renleu or wwyen tj1Su1budon box. Syswrn Q! p°-5 Ensoegign r('. i±. approval of Board of OAK): - __-- broken pipc(s) arc r6p?.Rced_ obswuction is removed s disA'1bution box is lcv-led Cr re:p'17C5d explain; f�fLZ The 5`Stern rfyl:'trcd pw-Pping trot,,, tin 4 blues 4,. eau su to brokcn or l)b$ '1-�ct:` , i S t _._._ y ' ,t 1} ,ire cs). 7e sYs,ern wi,i -ass inspection;f(w;Gh-approyal or Board of Health): brokin`1-" s) are rcplaccd - n —'obsunuction is renlov"d .,D explain t _ 2 t ,Page 3 of l I OFFICIAL INSPECTION I<OR)N7 - N01" FOR VCLU TARY , SSFSSNIE1 TS SU}�SLIIZI`AC'I' SL1'!,:iGE DISPOSAL SYSTEM INSPECTION FORM I,tk RT A CUR�Yi 1-� „ TIF ICATION'(continued) 1'rUperti' %•.ddress: j 0U1 Ee.f.ff R"L1_:nR. /?C,CLC/ J c o d Date of inspection; CV23 0 3 C. Further Evalusitiou is Required by the Board of lfealth: /,/C1 C.Ur J;IIUnS et.ici %s'h!Ch rcquue fll~'r;e.r e`aluatlon by the Board of Health in order to detennine if the system_ is la!lUlf;to proles! Public health, s:tlitj' or lf'`e CnVU'UgInClit• 1. ` .vstem will p,;ss unless Board of Health determines in accordance Nvith 310 Ct?vlR 15.303(l)(b) that the ``Y-ter is no( func(loning in 3 manner 1i'hich will protect public health, safety and the environnicrlt: bv Cesspool of lifts^; is `.vl(h;n 50 feet of it s!arface µ"atc'r Cesspool or privy is within 50 lee( of a bordering vegetated wetland or it salt marsh ?. S.,'stem ".ill fail unless (he Hoard of health (arid Public 'Nater Supplier; if any) determines that the s.'Sif"irI rS fUnCtlo.nln� in S! rfll nCer that protects the public health, safety and e.nyiroili-rent: i lie s,s(cft) il::s a sep(rc L:irik avid soil absorption systern (SAS) and the SAS is withil? I00 feet of a s:r ... 1h'ater Suppi,r of iribwar,, to a surface 'Water supp!l '. The S,IS tCP? has septic tar?.' and SAS Fuld the SAS is within a Zone I of a public 11'il(f'r Supp1`'. The Sys tCr has a sep(;C t ?1}: and SAS iUld the SAS is 'V'It}?111 5,rj fee( of a pl't1'i3lr' W'4 ter supply well. SY 1M has a septic tank and SAS wid the SAS I; less than 100 feet but a0 feet or rnore (Torn a Private water supply `,Dell' ?.•tethod used to detenniric distance °T h;s SVSIenI ;lasses II the well Waier analysis, performed at a DEP ceni'f'wd laboratory, for coliforrn bacteria %r?d volatile organic compounds indicates that the well is free from pollu(ion [rorr, that faciiir% and the presence,of arnmonia not-rogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no ot]ript lalluxe criteria Fire triggered. A copy'of the analysls,must be aRached to this form. 3. Other; r� ' t Page 4 of 11 OFFICLUL INSPEC11001 F&V FOR VOLUNI-A�RY ASSE-.�S.N.-E., S RM — IN C)-11" IF SUBSURFACE SMAAGEDISTOSAL SYSTEM INSPEC-1110IN F010111 PART A CERTIFICATION (continued} Pr op t rly A d d rei s:3 0 8 CeN Riven Hari q-.f— Date of Inspectit;T-9-77TTU-3 D. System Failure CHIer-in applicable to oil qsUmE You must Vdicate '"es"or"no" toxach olle rNhwhq for Ill hVeakrin Yes Ni - Back-up of sewage, into faciht.y Or 5ystcrl, component due to cwerkoaded or clogged SAS or cesspool Discharge or porKing ofeffl,lienl to of Surface of the. or surfacc—NzIters due (oan overloaded or clogged SAS or cempool ZStatic lkpdd level in me dkVbw&n box aboT oude, invert due to an overbaded c /Cesspool 1. /) or clogged SAS or 'Liquid depth 16'ssffi-an 6" below invert or available volume isles man 1.4 day flow -L-�l Rtquired pun-,pinZ rnore than. .1 tirr-o-'s in the last year NOT due to clogged Or ObmT-Uc(Cd pipC(S), Number o.; tilln-'s purnpcdl Z-L --5�Any porton orthe SAS, cesspool or privy is below high groundwwa elevatim. Any portion of cesspool or lark, is within 100 feet of-,j surface water supply or tl-ibutary to a surface walef Supply. f 01 nY portion0 a c spo or privy is within a Zone I of a public well. _)_n 'Un of a cespool or gin, is within 50 feel of yvate water supply well, yPO YPO-ion of it cesspool or 1.-,riv`Y is less than 100 Net but greater than 50 feel [Tom a priYme water Supply wib Flo accept-aW water quality analysis, (This system passes V the well eater analysis, pedwrMu"t a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the sycH is free from pollution froul that facility and the presence of ammonia nitrogen and nitrate nitrogen Q equal to or ins than 5 pprn, provided that no other failure criteria are triggered, A cOPY Of the a"Onis mum be attached to this form.] (Yes/No) The siitern Q11; 1 1jilye dc-,�Fnlij it 11" Illore of Me abon !time chwha m as determined led th, Oro'. or desci in 3 10 CN1R 15301 Terckm be lawrn W& The systern owner should contau the Boaka HKK to dewrinke whm Nvill be JlCCW',Saf') 10 COITCCt the fBllUfe. E. Large Systems: To be consider c-d a ljjq,e system the sqfem mmt serve a facility with a deign now of IVOOO gpd to 15000 g pd. You rilLISt indicate either"yese,or"no" to each of the following: (11-he C0110"ving, criteria apply to large sysurns K addition to 2;Kwha above) its no II e ys=i is withirl 400 Net of a suNce drijitkin water supply the sysicin is within 200 Let of a tributary to a su'j-face drirl]-,ing water supply the system is located in a nitiogen Se-IlSiLiVt "u-Pa (Ipterjtjj 1,'qeIHhead Protection Area-JWPA)or a mapped Zone H of a Public Water Supply weal If you have answered 'Wes" to by question in Section E the systern is considered it ApnRam Uman or I answered vt-s" in Section D above the 1arge sysiern has Wed. Ile ommr Or operator of any jar;, . systeqj -Onsidered a signi Acant Wes under Section E of faiiCd under Section 1D s1hajI upgrade the system in accordance with 3 10 CMR 15301 11C KUM owner Dodd cOnmm Me W`)Fime MOW office of Me ERpaament. Page 5 of I I OFFICIAL, INSPECTION FORM -- NOT VOL, ASSESSMENTS S UB S URY A C E S E W A G F 1—D f,'—S P 0�°A—L. S y S,T*h,j,,,j 1,.,N S 1,1,.,,C, DON F,O P,,A Pek R T B Properry Address; 308 E e e A Rlv�m Rem� --K-7— Ownm,Lzmeh 4J-00(7 Lai; ol i(!sp Ctiou, done. you t Inch of r:c fo 110 11 umpog information was provide by on O"Wen occupant, or Board of h'c tj I t 11 Were any Of the WIT tmlouws pumped out Q, the prWoust-WO weeks system received nomml flows U, the previous hvo ,,k I" lug' VOWMCS Orwatir bcm Moduced to the system rcccndy or as pan of t11i5 jjjpcci or I Wcrc as buil: plans or(he 5yslcrn obtai-ncid and cxjj-.-,trjcd? (If they crc not available note a-s 'NVA) U)c 'ill y eca wwqc back up 4Y`4s the Sit-: u)spvmd for A," of brnk out Were d) dnc SAS), located on site ""re the scodc tank WKS Win) ;red,opened, and the inicdor Whe tank. insptcl�d for (h� of;re Of& or leek mcdal of Com,'.nlc[ion. di;,-;,cnAons, depth of sic uil dtpdl of sludge and dcpQ!Qcon Was the raciliq ow ( m n p if5cmOm oniv) provided with infonnation an the prope! rnalnCnanCe of se aS? diSPOAl S.YSIC[Tts ? l fa sUe and 1"000n of At All Absorption Sptcm (S/,,S) of, he site lips beer, ,jcicm1incd based on. Yes /no Exklg nforinati0r. Fcr 0.1c BoLrd OfMcaiLh. DC-cri-nined Ln O o lot lxWmyrhNurc cWha restated to Part C 0 W muc approxhution of smuc Is (3 10 ci"'iR 15.302(3)(b)) Page 6 or! I OFFICIA-L INSPECTION FORM - NOT F'OR 'VOLUNTARY r,,SSESSMENTS SUBSUR-FACE. SEWAGE IDBPOS,�-L SYSTEM. INSPE'C'MONFOR-M. "ART C SYSTEM MOPMATION 30S A& Rio!, AM e"z Datt of F',......... ,p C C(i 0 n: -9 03 RISMENTUL F11,()%V C 0 iNiD 1-1'IMNS hNnOr of bed of bedrob ms (acrua[): DFS!G'e' (low 'based on. 310 CrYIER 13.203 ((Q( eXhrrlp I�: I 10 F�,d X Y Of b('&OOM5): Does residencc We a wwge p5der(yes or wak, h Oil S "rptlair lewlgc 4yinin (""ej 01' no):'a (if yes sepmte inspenion rquied) Ls..Lndfy (),SlimL-iipecttd (Yes or no): J,'Y sc&.Sona! vsr: (yes orrlo):2 V,"!Icr !cadiiiges, ifavadabW (hot 2 ,sit usage (gpd))?Q01 Sump pump (yes or nj"W L3, 000 '(jailonsQ30. N YPD Sp& -.7- W7253, 000 gaihoas=691. 15 gPD Lut dak of mupulcy: A,! .-.,)- ink tea system 16 psesent CON':N".E A CLkl.-111 D US TV A L Qaiionage includes house uAeape. -Type Of b I i S' ign flow (based or, _vpd Basis of de s i&n 11 c w(s a i-k-11)c i-i o n Vs q R,c t c.): G r or no); L)'j `.Fast. }lolling unk pusat (yes or no): ititl Non-tnil-i:-y %vzstt discharged to We 111c 5 systern (yes or no): L)J WaWr mcRr nadbgq I vabbW OT E'P, (,J c s;.-.r liJ e): --2 GEN E RA 1, ltYF 0 R:M T11 0 N Soncz ")CWhaud"Tone eta pumped &-s paj-t of Gnc sp (,iiorl (ycs or )7: H yet YoWrn; pumped: 0,--Qons How was quanthy pumped determined? 001540/10 R.CasQfl [or Pul-rip"""g: T'i V OF SYSTEM ,11,AQ UK MOM box, soil akswphn squin cesspool XJ'Shared s;s1C;1l ()'es or no)(if yet, httacli prcvi0ljs bi5pmion records, if any) - ,attach h my of the cufrent opci-Oon and rriaiwc,pance.- cono-act 00 W TWA born symm o"ner) 1*igi [ W,,k 1(1'e. Atuch S copy of'-hc DEPappro vp I Appro0m": He MY ca"ounM dak KsWkd Orbloml &nd sourer of information: ',Ycrc scw3gc odw de cd a ( ,.:L/ja scycs or no): 6 pqe 7 of I I OFFICIAL INSPECTION FORM NOT FOI2. VOLU'N'l'i-kRY ASSESSNIMNTS SUBSURFACE SEWAGE DTS?0S.,kL SYSTEM WSPECT ION FORK F A 11-11- C SYSMM INY-OR'-NIATION (continued) Property Address: .308 feei RiDeq Rood owrwrlymey Kpl- 9/,')3 BUTDING SEWER (locate on site phn) "D p belts. gad" ly�/I Materhis of consmudon: ,,Qam hon he t.-L,i 0 F V C .).o d r p x irn D k u=e &o m p i Y m c Mat'., supply or suction Con-oincrm (on condAwn of Am YeTing, evidence of leakage, e(C ): vented thnough ile noof mcntj. SEPTIC TA.�i<: -Xiocate on sitt plan))'conc rc(c ass jjQolyeQQc ne it i l! I i 5 a g C: is agc conf''..'!-ncd b Cenificme of Complimce (ycs or (Fi-t-t-Rch 8 copy of Ali Dis:zncc !,cm tc'p or t ju�gc �o bol",cm." ofoutlet tee a I c:ejoj'00 Dsti:t,.-e Amn top of "m tu top of('u I i e t c o r Damm hom Worn ofscmn m bnom or o4m tee or fn e: Alkam How Wa Imenskm demmle? Colmicna (an pwnping Pik, and outict te or baffle condition, structural bVegrity, louid levels as rMed to outlet Liven, cyiklmcc of kakagq cm): u J"(2 K" MIT(_'..T: lavell inveil 0 51'' GREASE TRAQUtymak on do place) D c p t}i below g-.a d e: h i m c d a 1 o f C a n i c i T o 0/1)c o ni r c r i i e" a 1 Cl b c r g I a s s, __polyethylcne,?LoLher Scum DAmme Dwn mp of mun T mp oumut ted or baffle: Disame hom bmcn.r., of scum to bottom of owict icc orbap"IC: Datc of last p-rnping: C Lonunem's (on pumping monunendations, inlcf, and cutin Ve or bailemondition, St-ructlaral Pitcgr-irv, liquid IcYcLs m rc!mcd to outict ",n-mt, cvidericc of lcak-age, re 71 7 Page 8 of I I OFFICIAL INSPECTION F0',ZN-'j1 Nl,-)'j' ],-'OR VOLUNI"I'ARY Ass-LssmEN,rs SUBSURFACE SEWAGE', DISPOSAL SYSTEM !NSPECTION FOR-N-1 P,,A,,1a'I' C A SYS"YE'NI INFORNIXPION (con'tinul'ed) Dale of I rt s e c ti o n: 9L?" TIGHT or HOLDINGTANX." (Lar must lb(� pun'l.ped at (irrie of inspectionl(loc te on site pla n? an. Depth '"mule: Ma,erial ofcons.-ruction: fiberglass,6 wlencK,� otiir.r(explairl): 0 Dimensions: ""Mons loll SM ay Al rm present (ves or no J: - L Marm level- �Y Ala.mm in Nt,,olrKinj,order 1\es or no' Date of idsi pil-1p;r1o: ilk Carnments (cCjr`,d;t;ofl of'alalrn and lIoa? switches, etc.': 7 1 0 q /2.0 p Cz-I'/Z 0/-1,/C<, (,-z�C1.' I z o 6 e n, DISTRIBUPION BOX: (if present must be locate on site plan) D I I F 1;0 t,id A -X Corn-1 e (n 01, Il b-D is 1 vel and distribution to outlets equal, al ly evidence of solids , anY evide lice of 1-alk-mle in o or ou,; of b ox, "IC.): 0 12.C_< o/Z NO e v rt c e o 5 c ci,,?,/z y C�v Pll o e e r, e,12 0 0 z 0 IL 0-/Z t h e 0 x PUMP Xalv on site plan.) Pun-ips in worl"ing orcier iycs or no): 1Lj Ah,irrns in working order(ycs or no): Cornn),ents (note condition of pomp chamber, condition of pumps and apPurtulLnces, etc.): A. Rage 9 of I I OFFICIAL INSPECTION FORM - l-�01' IFOR VOLUNTARY ASSESSMENTS SUBSUU- ACE SEAVWX DISPOSAK SYSTEINI INSPECT IONF0101 PIUAT cc SYSTEAd INFUIL Witt TION (continued) Property Address: 308 Eeei 004 Poad 73 t C,A-077":7 Owner: WrIme.6 mate of Inspection: 0 3 SOIL 113SORPTION s ,'sn-:;m (s,-�S): (locate on site Qn, exTavaton not requirld) a(,-h If AS not locatud exWah %0, —---------- T)pe !:'�'chi.rjg Pits, number: (I c a C I-,i.n.g C)I a,11 b C.rs, r.uni e 1-aching" number, Ungth: 1Cach ng rw!ds, nuln.ber, dimensions: overfllcw spool, number: AAj innsw0hyrnathT qatem of,ted"nolog Y: Comment (nwe chdition of sot!, of V&aulk NHurq level Uponding, damp soH, condhion of\Tgequon, CE SS P 0 01'..S42x§(ces spool m"'I)t bc' jpunlpCd as 'pai-I of inspect ion)(I OCaie on. site Plan) N-..in-.,b;:r and configuration: ------- D e q h—w p of 5 q,..i i d ;o inter in v c;-,: D e p 1 h of solids layer. Depai of scum layr: rr"-nsio.'-'s of cesspool: 2 1 e"ia!S of,,o 1�"�-ru c-n: lndication of gou!id,.vaier inflow or A'71, Cumnans (note condition of soil, anq&aac (:iM, level cFpcnding, condi(ion or vege wiow ca.): PRAWIry"L (locan on A pK0 "M at'.r i a!s o 1,c on"!I III c on: A# of solids: Conuncnt con i[icm of Soul, sills of)iydraulic I'dure, level of ponding;MAN of vegemion, ew.): 9 Page 10 of I I OFFICIAL INSPECTION FORM — i"10TFOR ASSESSIMEN-TS ' SUBSURFACE SE"IVAGE 17)."SPOSi'd, SYSTEM INSPECTf ON FOR-M PARTC Pl-(),DCrt)' Addres.5: '08 R."Vf .,z Road )006, Hou�,e Owuer: (.2 o?L, food_ Daic ol !llspectiori: 9123,103 SKETCH OF SEWAGE DTSP0F,Al.. SYSTEM, providc a of(he :("Rags dispos:d sif-sttm inc.lujing tics to at least two *per-manent reference lajidma,ks or !00 fn. Locatt wncrc. public %vialusupply cilters the building. "o r) .5 c I �:_� -� I. 10 Page I I of I I OFFICIAL INSPECTION FORM VcLUNTARY ASSf,..ssm'r-,N'rs SUBSURFACE DiSPOSAL SYSTEM INSPECDON FKA SYSTEM (continued) Property Address. 308 Del Wei Road NAMPA, 1012, own"Awy Clow Date of I aspection; 9/Z 3 3 SITE EXAM S5, Surface. water chec!". ccl!az Shallow wells Estimated depth to ground water Ncc.su i-nc'icat- W%tck) 2H methods imcd w Washe Tellh goud "Mulkeyethn: qfj MaKed tam smum clesign phms on record - Hchwclked, daisOfdcsign plwi eviewed: 91123103 kfj Oban ends ke (abuning Propotn Abu naon We Wh 0 1501`410WAS) 412*, Mcked %vith WN Boud of HeaRhaxMak: NA Ch"Ad M IT& excavanorb installcrs- (anach AxWenmtion) Accesud USGS dambasc-cxQain:Aj'J_SA U S, You must describe how )Tu eswWishd A Nand water cleyaHon: 721160"94 gRound Wea Mvaiionz agove sea level. -000- 7�.W- a j a A Was 7- —------ 7 - 000 gation faaching chum6ea 16. 5 'X! 3 ' li Il X2' z Gir c,Lm,j%I, or r'it Eigh Gro�incv--,atcr Aclj-,15tMu( pu Ftimpa Nhood scnai*a(ion Wrac Kwun the bovoW of leaching ph and the QWKd 90"Awmu MW a foci. TO � (.♦•W.Y111>�(IITO.�TT�\YOP�IR('I(TP\/CT'(11V>T.I'OY1(1:9r�AY(D/R.,l}790P0'YW>Y YpVMY'Y.Y@'YY Y 's.YYRQ'�1Y'9^_YTT9TgTYTTI}n!'4rfi�►�Vl91pBHEALTH V'�4+y.^Fp>gt\Yv/Tl'T@�:•R'YTTfC-YT:"-1.�TT�-• `u�-i>-- _ _ TOWN N O(' �1.1_ e � _ �(lr�ll k/f� �I L'1 L L H 1 SUBSURFACE REWACK ()(8i �,`:L Y.,I.;r`{ ,'.h.`�('i:dIION FORM PART D — CERTIFICATION � V�'g ...Y.y.Y..,...'.Yr"Y.i11�.!YY41.WT1.1'M.1YI Y1YW1•ih-"Y(Y"P'11Y('.\"_t'1.^'ItIY'nai'If1Y':vY'^'Tro'n'1...Yr4rT l:":'"^:e.Yn'1\M'I�'"WY"It/9"/"h3LTY�WM1YNON9NK91'Y'IWYITPHS1 P-11 v+n1YY(YTYy^'>PPY'TI(tY.'.+t('P'Y••.W•�. —. A ,-TYY'/. OR PAINT CLEARLY- lop , STRCE'T A9DRESS 'Gd cee.0 %k.l.r�e z. Road ��,S:f.e�t.v.�.( e, Na so. OWNER" s NAME lame lamez No jd . „>..—�—..,o>.•��4.,9�Y'.�,.~":•Ya.y,a....>x..�.�.,.t, .gym �,r ,d�..,z.�.,Y�., „��,9,,, _ "- —•— 1-;'Ai",.'E. I iiSP t,TOR Joseph [7 M ico,I? er Jr c o"""'P A i Y N'A i E �1, elf 1 C"_Q !l l:i!�:Y.'.�F`._.._S o n COiHPANY ADDRESS Box 6-6 Centervi..l ? .Mass' 02632 -- t t r e i.�._._w_.._.._.� -- ^--W-T-7 n' g r^1 t y - -- ------ 6 • ------- COMPANY TELENIONE ( 508 ) 775 - 3338 FAX f, 508 j •790 11578 �sY,.w'�:cun:m:�r -';�".svcn+xw�+rFr 4• C1,RTIF1 ,AT1-0iN S'i'A'i'k: fLPr'r I certify that I have personally Inspected the Sewage di ©pos'a system nt 1,:11his nddress rind that the information repotted is true., acct. rBte ; and inOmelet! as of the te of ,inspection , The inspectl.on : wa:� performed and any ecommendations regarding Ulayradle , maintt'.nance ; and r'epaii` are consiStent i th fity training and experience in . thy y Proper function Rn:d -maintenance of on site sei\,age disposal systems , Check one , ' The ins arc tiori lrtlic`1 I• 'h have cunduc,ted has not found any information %"Mich iI (? icates that the s ^ em rails to adequately tpublic y� t� 4 protect public Walk ov 0he envir0ililenL as defined in 310 CHR 16 ,303 , - Any failure criteria not evaluAt6d are as stated in the FAILURE CRITERIA section of 01is Corm , , a\ , System FAILED The inspection 1„I!; cl� ? have conlOcted has found that protect. the ;�Illblic 11i:nikli <nnci the ¢- �' system I'('. { is *0 e environment In accordance with T 5 , ? 10 } 5 ' 3103 , Inc! ss Specifically noted PART , Title C, `� r �t� o�, ,I T C � i�AILUR CRITERIA of this inspection- .form . insDectop 8ii:S1"it?,i;ur@? 1. k�f' f)� i ° // '�. r_.:r�i_v:lr:�r_-.:':=¢-r:.ire r.:r y:-.::�r�y.ra':::la'-�t'r*.`r�v:.tmrrxa:�i:t¢rt n--^.ea vmdc-z:.lv..>_'ex:va .,. cx[axrrs�l�.ro�• .m•,. / '6slY.i.7�s"-4xalLT�; •-..:fir._.-I i r� �cl this; Art1ficc.t.i.on must be Provided to the OWNER, the BUYER orc uppy .ck,b e ) and t he 1)QARD OV }t; /eLT", YLhe inypc,ct1 ;, l t )v ownor o C�j�o'rator FS}'lal1 uPgt`.L"mdo ' the 0y6t wUhin one year or the dote of the inspoction , S.1i'1lt-T39 Eli3.pFieG r1 -•� ' o !.he .. se as provided in JO {;-(' R 1J . 305 t c.Cli i' { yuc td , dor L ' No. Fee$ 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Oigogal bpgtem Construction Permit Application for a Permit to Construct( )Repair(X�Upgrade( )Abandon( ) El Complete System O Individual Components Location Address or Lot No. 308 E e 1 River Road Owner's Name,Address and Tel.No. James Wood Osterville ,Mass . 02655 356 Bridge Street Assessor's Map/Parcel Q O s t e r v i l l e ,Mass. 02655 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Desi ner's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.) .Macomber & Son Inc Box 66 Centerville ,Mass . 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X No.of Bedrooms 1W Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 110 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Installing 1-15 0 0 gallon tank 1—distribution 1-500 gallon chamber for the pool house toilet . ep acing line Irom the house to the existing septic tank, insLailing one distriBution box and new lines from the tank to the box an Date last inspected: the eXi sti ng pit. Raising covers on box & pit . 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 . this Bo o eal Signed Date Application Approved — ! Date Application Disapproved for the following reasons Permit No. Date Issued ,,,� No.•�' `? � �' - Fee 5 0 0 0 ' '+"` '•' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes °3 PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS ; 01ppricatiou for.Migoar 6potem Cougtruction Permit Application for a Permit to Construct( )Repair(X�Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 308 E e 1 River Road Owner's Name,Address and Tel.No. James Wood Osterville,Mass. 02655 356 Bridge Street Assessor's Map/Parcel .� / O s t e r v i l l e,Mass. 02655 Installer's Name,Address,and Tel.No.5 0 8—7 7 5—3 3 3 8 Des' ner's Name,Address and Tel.No.5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.I .Macomber & Son Iac Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: Dwelling X No.of Bedrooms 4- Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3 x 110 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. • Description of Soil Nature of Re airs or Alterations(Answer when applicable) I s s t a l l i g g /1-15 0 0 g a l to n tank 1—distribu.tion 1-500 gallon chgaher for the pool house toilet. ep ac ng ine trom the house to tine existing septic tank, 11asLa-1111ing one distribution box and new lines from the Lank to the box an Date las`t;inspected: the existing pit . `Raising covers on box & pit . 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 b this Bo o�Hea t . Signed Date G Application Approved Date f mot` Application Disapproved for the following reasons Permit No. Date Issued t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS n (Certificate of (Eom'pliauce THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (XX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 3 0 8 E e l River Road O s t e r v i l l a,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No _ 9�6dated -- e F 1�1. Installer J.P.Macomber & Son Inc. Designer J.P.Macomber & Son I c . _ A e The issuance of this permit shall rof�b o trued as a guarantee that the sys�tefn will fu ction as design d. Date �. U Inspector ` �� Im �� ►'V No. ------------------------- Y' � Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS It!5po0af *pztem Cou5tructiou Permit Permission is hereby granted to Construct( )Repair�X )Upgrade( )Abandon( ) Systemlocatedat 308 Eel River Road Osterville ,Mass. 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: Cons ctionn must be completed within three years of the date of t it. Date: ! `� Approved y- _._ . .0 L TOWN OF BARNSTABLE r. LOCATION 30d, iff q_1 ,g_ , '2c> SEWAGE # VII.LAGE 4t v .IIS' ASSESSOR'S MAP & LOT 'O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I �O LEACHING FACILITY: (type) J:�)Q, (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i f v;