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0064 KING ARTHUR DRIVE - Health
64 King Arthur* Drive Osterville A= 145-040 TOWN OF BARNSTABLE :LOCATION t�j/\C, ✓A eU/ SEWAGE# }VILLAGE Q snx �� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r' LEACHING FACILITY:(type) Cx. (size) I OW NO.OF BEDROOMS 3 OWNER A 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 .S FQr �j' i O .a Y as a 3 11 31 e 4 co L,�..0 A T ION SEWAGE PERMIT NO. _ /, T LAGE -:To A /L) �� INST LLER'S NAME i ADDRESS OY- 3� �5 720/L/S Z22 L i s B UILDER OR OWNER L��T�L- ��ti5�r2vGT/��•v 0 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �OZ ©, No......7 .. U Fizs....a d G THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H TH ..'....!1 - ................OF........ ................... -- ......... Allp iration for Uispoia1 Warks Tonotrnrtion r i Application is hereby made for a Permit to onstruct (te�or Repair ( ) an Indict 'S Disposal System at: .....�-�.� ?. ...�...... ...�.1...... 1... ... - ..........................G c/G�c, -�� ..... ................. ..I. �. _Ad �I.ot '.-- .... ..0. --•-- -- - - ....... . -----P C •.. c. � ., �/.1 ........... Owner G .Address a -•..................................... Install Address dType of Building Size Lot._.C4 ......Sq. feet U Dwelling.—No. of Bedrooms........ -------_----_--_------ Expansion Attic (! Garbage Grinder ( j- Other—Type of Building ..#.fly.. .......... No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --•••--•--------••..................� �yx' ------------..-- W Design Flow........_" ................gallons per p day. Total ily flow__. ----------------------------gallons. R: Septic Tank—Liquid a acity._._1.A. allons Length ...... Width................ Diameter... W P 9 P � g g ------------- Depth................ Disposal Trench—No..................... Width.................... Total Length. ... Total leaching area.-.........._.......sq. ft. Seepage Pit No........I_.____.__-- Diameter......./4........ Depth below inlet....... ........... Total leaching area._. JC)------sq. ft. Z Other Distribution box Dosing nk / Q ,-�- '-' Percolation Test Results Performed by...... 1. L d �?✓`�,lL�./7�l�,.......... Date.... W -- - ---------•• Test Pit No. I.�._.,....minutes per inch Depth of Test Pit------j.2........ Depth to ground water----A/.0.P"V'Q-- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pr' ............................ -.. O Description of Soil.............`a•--------�d'a-�N.�'--- �'-'.. ------. -� � �`j'�..�.. - x U --•-------------- ----------------•---------•---- W VNature 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in� operation until a Certificate of Compliance has been issued b h board of h It 901 Signed......x- . -. -.TL------ -- - •------------------ Date Application Approved By-•---------. � ...... r ..._._..../1'/2......7_ Date Application Disapproved for the ,ollowing reasons-------------•--------------•---•----•-------------------------•-------------------------------•-•.............� ............................................................. ......................................................................................................................................... ).. ! Date'. . / Permit No...... _ h �- 7 2f...-•---•--------•------•••-------------- Issued---------1--.. --•- -----------------•-••••-. Date kt > F No.._...7 Q... :. ....c22_.'�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H TH •r .....................oF.-.-.. :.... --....-: . .- ----- .:ppliration for Bi-spusal Works Tonstrnr#iun rrm � Appl>c'tion"is hereby made for a Permit to onstruct ( or Repair ( ) an Individual Sewage Disposal System at: . ............................................... ,y — L -Ad s r Lot a. 4 Owner Address 1.4 --•...... •-•- _...._ Installer Address U �>Type of Building Size Lot__/�"j_Q_?90..._..Sq. feet Dwelling—No. of•Bedrooms:____.__;______________________________Expansion Attic (./ '' Garbage Grinder t$410' ' Other—T e of Building _.__..... No. of ersons___..________________________ Showers — a yp• g --��1�=�` p ( ) Cafeteria ( ) Other t res - -•-••-• •----- Design Flow........ 11#�_________________gallons per per day. Total gaily flow , � gal W ......-•.................. :.....•ions �. . WSeptic Tank—Liquid capacity ft O.P_gallons Length..... Width................ Diameter----------_..... Depth................ x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area..................._sq. ft. Seepage Pit No........I----------- Diameter.......14.......... Depth below inlet....... �_4e7)....:..... Total leaching area___ ... sq 1t. Z Other Distribution box (j ) Dosing VIV44)-ej Percolation Test Re ults Performed by...___ ___._..tQ!4?AX�"' _t._...._.... Date__ .''_ '. 0 ............ Test Pit No. 1 ___.,,,.__.minutes per inch Depth of Test Pit.....))-_.._____ Depth to ground water.....AJ.d -- �T4 Test Pit No. 2................minutes%per inch Depth of Test Pit.................... Depth to ground water........................ ----------- = ------ -.........-••-•--••......__.... --............ D Description of Soil........!p"_'.� +tM:f... "R' i x W •••-•••-•-•-•-••••------•••-•-•••••••-••-.._.__...r;........................................................... - ------------------------------•--...---------......_..---•-------------------- UNature of Repairs or Alterations—Answer when applicable.........._ ___________________________________:: ...................................... . ------- ---=---------------------------- ------ Agreement: n The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TILT L;. 5 of the State Sanitary Code— The undersigned further agrees.not to place the system in operation until a Certificate of Compliance has been issue4bb_vt,1h oard of h It Signed x =------- ----------• r•_ Dat" Application Approved BY------------- ��1_ ----------- ------------------••••••----------------- •--•••-•- -••••••-- ' Date Application Disapproved for the f lowing reasons-------------------------------------------------------•----------------------.: .........--a•_............ -------------------------------------------------------------------------------------------•-------------.._....__.._.__...-------------------------------------------------------------------------•_--- Date Permit No......221fi` //. �'7> �' Issued Date THE COMMONWEALTH OF MASSACHUSETTS '. BOARD OF HEALTH ::..:.................................. ..........................................................................._... Tnrtifiratr of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...............f Q-_,1'` � !_ - at ....-- -•••••--••••_... taller Ins . -� S•• -•-•--• -• _. _. ......................................................................... been installed in accordance with the p visions of TITLE, 5 he State Sanitary Code as described in the application for Disposal Works.'Con"Struction Permit No... :.. . .................._....... dated_..... _ -_ ____._.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM! WILL FUNCTION SATISFACTORY. DATE............. --•----• Inspector ..................................-----------_•-••----•----------••---- THE COMMONWEALTH OF MASSACHUSETTS _ a BOARD OF HEALTH 7 .................................OF..--. '% lr Jrl7 t 4 _..........._.....-._...................._.. dl.� ' No...... ___ .A........... ......_.. FEE .. . Disposal parks �nnstrnrtivit rrmit �, Permission is hereby granted_-________�G �______-__Cd "----.:;r___ #?`¢`-'_1 .. LS...: ........ . ..... . ... to Construct O or Repair ( ) an Individual Sewage Disposal System . ...... t--S---------------- ---...------------....-._...------•----------..._...-----.....at No.... ......._ �....��� .. s .�h &rxc c. Street as shown on the application for Disposal Works Construction,Permit No.....7_e? _____ Dated......... f 7 f ---- `.... -- . y /� ��a Board„d,�rHealth DATE............•-----•-- -••--• ---•-•----••---_.._. .. (�A FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS- xr s F y l THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A , I / �C(�'-J L DATA L-,4 F G.pv. sf 1 tt7 -t�/at.t_ Art=A, = tSo S.P. ► -- 8 TaTaL 425 'T-C>TQ L teat L�-( 1~LC)�,kl - �,(q� re �xP t t-fZC-0L&T10c..1 CZ.I&Tir : l �tJ ��{�tJ 01Z �1~55�. 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(� � �• � sa,, L` _ � � � _. ✓upjA ALl- AeP-A = (So S.P. 1 t4 2.S. 4; P.V. i 't'G7Ta� 't:7 1Gl.1 = 425 -Iz>-I-&L 6.PD. 1 t LSZGDLQTt0Q O&TE 4r�+Q .lL AA Q OCL LESS. o 4;\N � r 4 PST 9 � I �..., ,,,w No K Tor V,4t> +.�tk�Qtir� �� � c��• t. yy .' 4� ... ��� i►a ..a r-q4, y 97Re I ncx� iWV. �+ LOAM see 4°Pp� vrr;r !w. (SAL -Box 9c.�.5 Sr-Qr►c o luv. O iud• ., GAL. U./3 1.G.30 Ls�aa N A , { Kull PST �: I shmrw►ru was,aEv STo,..►� $ .ad t C.c ZT �C—. _P L cb*T' PtzO�`tl._ LOCATIOt-4 OSTER_Ytt�L.E r.� ►jC> scat ��t_tw; IiM.= Goer A.`�'C 10A, I`18 I i'r' �YAT�[2 �Z�►���7 �.ELA A r T i-1 C—_ rza a r3 per-%r i o!4 5 Wch.0►.t Pt A h 1 1Z IY►-,-. �.1 c.�:. ! ,a c.►;[ a.a t ttititi C>L�(� tiv!-t•4 TW-• 51 v r U. -aC_ L. o T 9 --- r}WL> t.C'rj?,ACIC V r tJ1 CAA i-1p; O T Ht: 1 G, 4 GO 8 S. ',..,W►-2 Of— B A.R N 5-r t.,..V-- � tZCGI� i''�IZ�D iJ�.6.tCj •�U2V%=Y•,, . � �t•R-�I � C��.n I.-i I ., Li o`r t�•a,C.L7' v�.a A+►.1 ► 4 'Ti4L c F �i Cti ;!•1t:lJl � + .t' i;C. 11-.C.�•� C�., i>r j'C t�A,Mt►al=,: Lca'T' t_lt�t,:=.3 -- � ' COMMONWEALTH OF MASSACHUSETTS a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF,ENVIRONMENTAL PROTECTION ' TITLE J OFFICIAL INSPECTION FORM-.NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 64 King Arthur Drive Osterville. MA 02655 - 0 -T�b53 Owner's Name: Nicholas Anagnos Owner's Address: Date of Inspection: August 6. 2009 Name of Inspector: (Please Print) Janes M. Ford' Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville..MA 02655-0049 Telephone Number- (508) 862-9400 CERTIFICATION STATEMENT I 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 only training and experience in the proper function and maintenance of on site sewage disposal systet2n„S11 1 am a D.HP i .approved system inspector pursuant'to Section 15.340 of Title 5(310 CMR 15.000). The syp(" m: cn ✓ Passes „: _ -n.: E Conditionally Passes "w t N s Further Evaluation by the Local Approving Autlority ail Ins ector's Signature:. Date: August 6. 20 rn Q The system inspector shall sub t a 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 systein owner shall submit the report to the appropriate regional_office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. F Title 5 Inspection Form 6/15/2000 page 1_ Page 2 of 11 e � OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION (continued) . Property Address: 64 King Arthur Drive Osterville,MA Owner: Nicholas AnaQnos Date of Inspection August 6. 2009 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all_of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303.or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system;upon completion of the replacement or repair,as.approved by the Board of Health;will pass. Answer yes;no or not detennined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic.tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain; The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board',of Health):' broken pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 King Arthur Drive Osterville. MA Owner: Nicholas Anagnos Date of Inspection: August 6, 2009 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: s 1. System'will'pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within.50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within,100 feet of a surface water supply or tributary to a.surface wafer 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 1.00 feet but 50 feet or more from a private water supply well". Method used to determine distance *This system passes if the well water analysis;performed at a DEP certified laboratory, for coliform. . bacteria and volatile organic compounds indicates that the vrell'is free from pollution from that facility and the presence of aimnonia nitrogen and nitrate nitrogen is equal to.or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must:be attached to this form. 3. Other: . 3 Page 4 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address:. 64 King Arthur Drive Osterville, MA Owner: Nicholas Anagnos Date of Inspection:. August 6, 2009 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 groundwater elevation._ _ ✓ Any portion of cesspool or privy is.within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within:a Zone 1 of.a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool.or privy is less than 100,feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria.and volatile organic compounds indicates that the well is free from.pollution from.that facility and the presence of ammonia nitrogen and nitrate_nitrogen is equal to or less than 5 ppm,provided that no other failure criteria Are triggered. A copy of the analysis must be attached to this form.] 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 determine what will be necessary to correct the failure; E. Large System:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 . gpd• You must indicate either"yes"or"`no"to each of the following: (The following criteria apply to.large systems in addition to the criteria above) Yes No the system.is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply : the system is-located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a .significant threat under Section E or failed'under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional:office of the Department. 4 Page 5 of 11 0 OFFICIAL.INSPECTION FORM NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Kinl,Arthur Drive Osterville,11A Owner: Nicholas.Anagnos Date of Inspection: August 6, 2009 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,.occupant,or Board of Health . Were any of the system components pumped out in the previous two weeks ✓ _ Has the system received normal flows in the previous two week period 7 ✓.. Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were,not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up ✓ Was the site inspected for signs of break.out? ✓ Were all system components,excluding the SAS,located on site ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided'with information on the proper maintenance of subsurface sewage disposal systems? The size.and location of the Soil Absorption System (SAS)on the.site has been determined based on: Yes No ✓ Existing information. For example, a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria.related to.Part C is at issue approximation of distance is unacceptable) [310 CMR 15302(3)(b)]. 5 Page 6.of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM k PART`C SYSTEM INFORMATION Property Address: 64 KinzArthur Drive C Osterville. MA . Owner: Nicholas Anagnos Date of Inspection: August 6, 2009 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if.yes separate inspection required] Laundry system inspected(yes or no): . No Seasonal.use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or.no): No Last date of occupancy: Currently COMMERCIALANDUST'RIAL Type of establishment: . Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to.the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: . Pumped after inspection Was system pumped as part of the inspection(yes or.no): Yes If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping`. Maintenance 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: Date of installation 311 311 9 79per as-built.card 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:. 64 King Arthur Drive. Osterville, MA Owner: Nicholas Anagnos - Date of Inspection: August 6, 2009 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water:supply well or suction line: Comments.(on condition of joints,venting,.evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 15" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _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: 7" Distance from top of sludge to bottom of outlet tee or baffle: 30:' Scum thickness: 8" 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 detennined: Measuring stick Comments(on pumping recominendations, inlet and outlet tee or baffle condition,,structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc:): Cement tees were present. The liquid level was even with the outlet invert. .There did not appear to be an signs igns.of leakage_ The tank was pumped after inspection. GREASE TRAP: None _(locate on site plan). Depth below grade: Material of construction: concrete. ._metal fiberglass _polyethylene _other (explain): Dnnensions:. Scum thickness: Distance from'top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural.integrity, liquid levels as related to outlet invert,evidence of leakage;etc.): • Page 8 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 64 King Arthur Drive. Osterville, MA Owner: Nicholas Anaznos Date of Inspection: August 6, 2009 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of constructiom.._concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day . Alarm present(yes or no): Alarm level: Alarm in.working order(yes,or.no): Date of last pumping:. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: . ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-Box was normal PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alanns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 64 King Arthur Drive Osterville.MA Owner: Nicholas Anagnos Date of Inspection: August 6. 2009 - SOIL ABSORPTION SYSTEM(SAS):. ✓: (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'W leach yit 1000 gal. leaching chambers;number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system .Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding;damp soil,condition of.vegetation,etc.): The pit had 6"of water'oh the bottom. The scup:line was at the scone level There did not appear to be anv sijZns offailure.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: Depth of solids: _ Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): Page 10 of 1.1 OFFICIAL INSPECTION FORM-'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 King Arthur Drive Osteeville..MA Owner: Nicholas Anarznos Date of.Inspection: Autrust 6. 2009 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: � 3 . Y as a a� PO 3 II 3 � to i Page 11 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 King Arthur.Drive Osterville, MA Owner: Nicholas Anagnos Date of Inspection: August 6, 2009 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40+/ Meet 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: Topogrrgphic and water contours inaps 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 showtng approximately 40'+/ to-Around water at this site. This report has been prepared only for the.septie 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 ..