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HomeMy WebLinkAbout0097 MAIN STREET (OST.) - Health "'97 MAIN STREET, OSTERVILLE ri,r, i 0 r R,EGFI\r FRIEDLINE& CARTER ADJUSTMENT, INC. AUG 2 3 Jul i 436 Main Street, P. 0. Box 338 �HK jh'aI1I115, Massachusetts 02601 TOWHEP& ID'"' Tel. (508) 771-3232 FAX (508) 790-2344 TO: O Building Commissioner or Inspector of Buildings and of Health or Board of Selectmen O Fire Department TOWN OF BARNSTABLE TOWN HALL HYANNIS, MA RE: Insured: MEE, Michael Property Address: 97 Main St. Osterville, MA Policy Number:' CBSP71830 Type of Loss: Water Date of Loss: 8/14/2002 File#: 94205 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed$1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the ' addresses indicated above by First Class Mail. R. F.LASKO Adjuster 8/22/2002 I` l l. ,1 tS jr w� n.aJ.�. J•�k£ �s{ � o+.:x. • 139.8 I1I . BORTOLOTTI CONSTRUCTION, INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 etaf 508-771-9399 508428-8926 FAX: 508428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO E PART A ERTIFICATION Property Address: A-9 9�&vj, , Date of Inspection: Inspector' me: er's N e and Address: CE 111MCATION STATE ENT ~ I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection.The inspection was per- formed based on my training and experience in the proper function and maintenance,of on-site sewage disposal syfstems. The System _j�Passes 'Conditionally Passe x Needs Further do B e Local Aproving Authority Fails Inspectors Signature: Date: / Q'� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTIONS 1 MARY� A)SYSI PASSES y I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR15.303. Any failure criteria not evaluated are indicated i below. B)SYSTEM CONDITIONALLY PASSES; - One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in instances. If "not determined",explain why not. - The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or i exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conformiryg septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water.level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): . - 1- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced. i _ Obstruction is removed Distribution Box is.levelled or replaced The System required pumping more than four 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-:. _a_.. 1 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 toprotect the public health,safety and the environment.;' , 1)SYSrIiM WILL PASS UNLESS BOARD OF HEALTH'DETERMINES THAT THE ` SYSTEM'LS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE ' PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC.HEALTH AND SAFETY AND THE ENVIRONMENT:-i' .. , The system has aseptic-tank and soil.absorption system and is within,100 Feet to a surface water supply or tributary to a'surface water supply.. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private f water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet,but 5�0,r Y Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. ; D)SYSTEM TAILS: > ' I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health; should be contacted to determine what will be necessary to correct the failure. ' z Backup of sewage into facility or system component�due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 Clog- J ; god SA&or cesspool.m, Liquid depth in cesspool_is less than G",below invert or available volume is less than 1/2 day flow. Required pumping more.than.4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- ; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy'is below the high groundwater ~' elevation. Any portion of a 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. if the well has.been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to,a large system in addition to the criteria above: ' The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant. threat to public health and safety and the environment because one or more of the following conditions exist: 1 , `y The system is within 400 Feet of asurface dnnking 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-Protectionrea A ' (IWPA)or`a mapped'Zone Il of a public water supply well The owner or operator of any such system shall bring the'system and faciliy into full'compliance,with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00: Please consult the local-' regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST .. r:,�J: -.� gr.;i gtf r •^iP ny.,.s..,;! „ H`x.ddic^ei'gcd a: ......- Check t1he following have been done: Pumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast 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. VAs-built plans have been obtained and examined. Note if they are not available with-N/A. The facility or dwelling was inspected for signs of sewage back-up.: system does not receive non-sanitary or industrial,waste flow. " The site was inspected for signs of breakout. , .;. a •4.~ ,. ✓All system,components;excluding the Soil Absorption System,have been located on site..' e septic tank manholes were uncovered,opened,and_the 4nterior=of the septic tank was;m- �' . t i,I: for condition of baffles 4or tees;material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. •': ,, ,x { The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- R _ "- SUBSURFACE.SEWAGE DISPOSAL SYSTEM:INSPECTION FORM PART B r Y CHECKLIST(continued) - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C_ SYSTEM INFORMATION i I FLOW CONDITIONS RESMIrNTI Design Flow: tons Number of Bedrooms: NutSbg r of Current Residents Garbage Grinper* ") Laundry Connected To System:_ Seasonal Use: Water Meter,Readings,Mimi Iable: Last Date of OccupancyAWIYAZ COMMERCIATANDUSTRIALo T*'of Establishment: Design Flow: nallons/day ,,Grease Trap Present"(yes or no)' Industrials Waste Holding Tank.Present:,.-.--.- _ Non-Sanitary Waste Discharged-To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER:; Describe) Last Date:of Occupancy: GENE FORMATION PUMPING RECORDS.and source of informa ion: System Pumped as part of inspection:_ If yes,volume ped: gallons Reason for pumping: TYPEf 3F SYSTEM: • _I.-'Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach.previous inspection records, if any) Other,(explain): ROXIMATE AGE of all components,date installed(if kn wn)and so f information: . S e odors detected hen arriving at the site: -4- - •I , SUBSURFACE SEWAGE'DISPOSACSYSTEMINSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grader '� Material of Construction:• concrete metal FRP Other 1�»+_ Dintisions:16471 X l Sludge Depth: -Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: . A4P#.e— Comments: (recommendation for pumping,condition of inlet and outlet tees orb es,depth ofIi d - lgxfl in anon to et invert,structural integrity,eviden of leakage, etc.)All (,Z / 1 GREASE TRAP: i Depth Below Grade: Material of Construction` concrete metal . FRP Other:- (explain) — — Dimensions:..__ �. Scum Thickness: •�;.- Distance from top of scum to top of outlet We or baffle: f Comments;.(recommendation for pumping,condition of inlet and outlet tees or baffies,'depth of liquid`" _. level in'relation to outlet`invert,stnicluraf iiitegnly,;yevidcnce`of lcnkage seic.) .., •• - . �.. _, ..... TIGHT OR HOLDING TANK:�e) Depth Below Grade: Material of Construction:_concrete_metal_FRP Otiter(explain) Dimensions: Capacity: gallons Design Flo«,: gallons/day Alarm Level: Comments: (condition of inlet tee condition.of alarm and float swi(ches;-etc.) s DISTRIBUTION BOX: I/ Depth of liquid level above outlet invert: Comments:(note if 1 el and distribution is equal,evidence solids car •over,evide ce of leaks a into or out of x,etc.) PUMP CHAMBERO `Pump is in wo lung" �d �tt 4 ffa j#r. tk r i `rIIj,{.F x<�.. d i ...• order s Comments (note condition ofpump"chamber,condition of pumps and appu'rtenatices,etc.) g SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOEL ABSORPT1011 SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits,number:Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Comments:(note condition of soil,signs of h draulic failure level of pondin conditio of eetadon, ale. / # .i CESSPOOLS: 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level,of ponding,condition of vegetation, etc.) .. .-..,...--......- .........__�......-_._..,..�-.-�....,.` _....4„ ,M. ,. ..r...i ..i..k.._....a: .. ... _ ;jam.. .. .. „..... ... -6- SUBSURFACE!SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART C °e SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. - C/"� e DEPTH TO GROUNDWATER: Pepth to groundwater: Feet' Method of Petermittion or Approximation: X1 � � Ili 5; -7- �r-.M���•'�`ts ',..4a�r '�1 ��c via,; c BORTOLOTTI CONSTRUCTION,.INC. ' .765 WAKEBY ROAD MARSTONS MILLS MA 02648 }� 508-771-9399 508-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I CERTIFICATION Property Address: 19 /Uf Date of Inspection: .9- Ins c G.� tor's Name: - Ow,►er s Name and Address: CERTIFICATION TAT MEN r I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal stems. The System: Passes Conditionally Passes Needs Further E luation ye Local Aproving Authority Fails Inspector's Signature:. " Date: (A The System Inspector shall submit a copy of this inspections report to the Approving authority with in thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INS PE TION SI1MnRARy A)SY3M'PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evalua below. ted are.indicated B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not: The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will.pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (conlimicd) Broken pipe(s)replaced Obstruction.is removed Distribution Box is levelled or replaced The System required pumping more than four 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 C)FURTHER EVALUATION 1S 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 the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH.DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and-soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from,a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS:" I have determined that the system.violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day flow. Required pumping more than.4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. if PART A. CERTIFICATION.(continue Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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.l 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.' If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile.organic i compounds,ammonia nitrogen.and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System).and the system is a significant, threat to public health and safety and the environment because one or more of the following.. conditions exist: a 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: The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART Q CHECKLIST Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. _None of thesystem components have been pumped for atleasl 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, __j,!:!�As-built plans have been obtained and examined. Note if they are not available with N/A. __j,,�)°he facility or dwelling was inspected for signs.of sewage back-up. The.system does not receive non-sanitary or industrial waste flow. Tle� site a was inspectedg o for signs of breakout.. T/?ill system components,excluding the Soil Absorption System,have been located on site. ` __'_The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, d th of sludge,depth of scum. he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- ±5; ,t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART [; CHECKLIST(conlimied) t/ The facility owner(and occupants, if different from owner)were provided with information on the.proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM S FORM TEM INSPECTION PART C SYSTEM INFORMATION FLOW CONDITIONS C Design Flow: . q!e allons Number of Bedrooms: Number of Current Residents: ( �Y7 Garbage Grinder: Laundry Connected To Sxstenr. e Seasonal Use:_,iL/�� Water Meter Readings, if available: l5�7 Last Date of Occupancy: , e— L k " /i1 `. COMMERCLALi NDUSTRLAIa/ Type of Establishment: Design Flow: gallons/day Grease.Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary.Waste Discharged To The Title V System: Water Meter Readings,.If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERA[ INFORMATION PUMPING RECORDS and source of informaf n'4�jine System Pumped as part of inspection: / (� pumped: gallons Reason for pumping: TYPE F SYSTEM: eptic Tank/Distribution Box/Soil Absorption.System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): PROXIMATE AGE of aJ coTponents date installed(if known)and source of information: o e .2, t , Sewage odors detected when arriving at the site: -4- v t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATIONS (continued) SEPTIC TANK: Depth below grade: Material of Constniction: 6 concrete—metal—FRP, Other (explain) — Dimisions: Sludge Depth: Scum Thickness: G/) Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid 17fl in relation to outlet invert,structural integrity,evidence of leakage;etc.),7._ S / ) ✓yam^ GREASE TRAP: Depth Below Grade: Material of Construction concrete metal FRP Other (explain) — — Dimensions: Scum Thickness: Distance from top of scum to top 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.) TIGHT OR HOLDING TANK:.(0 Depth Below Grade: Material of Construction: concrete metal : FRP Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: / / Depth of liquid level above outlet invert:4)0/` � Comments: (note if evel.and distribution is ua1,evidence of Solids�arryover;evide ce oft a 'nto or ut of box,etc t E, PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) _E i 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): ti (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits, number: Leaching chambers, number: Leaching galleries,number: Leaclung trenches,number, length: Leaching fields, number,dimensions: Overflow cesspool,number: Comments: (note condition of soil,signs of li auli failure,. el of ponding condition of ve etatio , etc.) nF' r, - GG 0 GfIc a';�j b!�,,,. Cc. iI (Yc» CESSPOOLS:. ------------- 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(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,. etc.) -G t' i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH.OF SEWAGE DISPOSAL SYSTEM: —. Include ties to atleast two permanent references, landmarks or benchmarks: _ Locate all wells.within 100 Feet. C--act/' 9 DEPTH TO GROUNDWATER: Depth to groundwater: r Feet S' / Methqd of Determination or.Appr xima Jon: 7_ ..: r No. FEB.� ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S�� ................OF... 1 �� t�`� .. ........................... AVVIirativu for Bi-4poii al Workii C onstrurtioaa rrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal �- System at: ................__.---.----...-••....-•----•----_••----...:-----..._-_....�---•--------- -------------------...- -T--------7..--........------------------------................. ocatron Add re s -� j or Lot No k. �1.�1U� �s.._..! lle .T.. `S MJ/_.N.sT,. Owner Address Arthur Sears& Sans Inc 313 Hokum IT. Rd a Installer Address DF2T2TS `r Type of Building Size Lot.....1,_14A� . eet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (wo) Other—Type of Building ............................ No. of persons............................. Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------- . w Design Flow...........5....J .......................gallons per person per day. Total daily flow____-___--_.4�...................gallons. WSeptic Tank—Liquid capacity!_;:F4 dgallons Length___/_......... Width......4....... Diameter________________ Depth____6._.:._.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No../_---se...Z_. Diameter......1.3....... Depth below inlet..... Total leaching area.6-67 ...sq. ft. Z Other Distribution box (� Dosing tank ( ) `" Percolation Test Results Performed by.4'eOI��9K... L� -_$�....CQ._�............................ Date.../................................... ,aa Test Pit No. 1.G..Z____minutes per inch Depth of Test Pit----1-4 4__`_` Depth to ground waterl_\\i.0....CIV..— fTq Test Pit No. ...minutes per inch Depth of Test Pit.---1.41.4..... Depth to ground water4'_ovJV7ffe_6b a ........................................................................................................................................................... Description of Soil-- f---`---Q��_Llg.�� _L OF},(+ --•- v ----©��'- --1 f3 .. —. .. .. W -•-•---•-----------------------------------------------------------••---•-------•----------•••-•-•----------------------........-------------------------------------------------------------------••--- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------••------------------------......------------------------------------------------------------------------------------------------------------------•-••------.....---- Agreement: The undersigned agrees to install the aforedescribed Individua ewage Disposal System in accordance with the provisions of.'TT LE 5 of the State Sanitary Code— The and s- ned further agrees not to place the system in o ation urtificate om liance has been i ued by the alth. d gned_.. ._ tau .: F��� ne .... ate Application Approved BY Date Application Disapproved for the following reasons:-----••--------•---------------------------------------•---------------------------------------•--•----•-•••---- --------•-•-......----•------------------------------------------------•••••-•-------------•--•-•-••••_.... -------------------------------------------------------------------------------------------- Date iPermit No............2-6................................._s:._.. Issued........................................................ . - — ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Uiipuual Works Tonstrurtiun Permit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal .- System It: ................__....__...................................................................... ............................ .......7 ---------- --------...._.---- Location Address or Lot No_ ...... A.-MIJ....--------•-- lur?. Owner % Address a X ... 5 r ev{ .............................................. Installer Address d Type of Building Size Lot----- L_J1�../9C -4et Dwelling—No. of Bedrooms...............'��.........................Expansion Attic ( ) Garbage Grinder N6) p.l Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtyres ------••--•--•-----••-•-----•••• • W Design Flow..........-� �........................gallons per person per day. Total daily flow............: Q•..................gallons. WSeptic Tank—Liquid capacity�$4qggallons Length---1 l-_....... Width......42._�.._ Diameter________________ Depth.....4........ x Disposal Trench—N ..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No../... ...Z_. Diameter_._.. . ........ Depth below inlet..... _t..1.7__. Total leaching area_:�.:,>_.Q...sq. ft. Z Other Distribution box (>Q Dosing tank ( ) Percolation Test Results Performed by.6 Q !�i�.._�cvw.. ....cU_.t.............. Date---/......z _' U........ Test Pit No. 1__ ..z....minutes per inch Depth of Test Pit...../- 9.1.:. Depth to ground water./.v.Q.T."-CEiV- fs, Test Pit No. 2. .z_..minutes per inch Depth of Test Pit....L.5?7.1_.. Depth to ground waterCv N.IFi.GO -------------------------------------------------- _..._......._----....._--..........- ----- ---- ..... . �.. ...-----...----....... -/8" O Description of Soil-- ---'---.Q. -- .-L Di9---M-------- - - � _ � . y SU14-_ ../....... ..... ..... xZ ••-U• zg..�:: oi9M-.._ __.Sx3Sc�ILt .:'...-./.4.4..... !'1. .L?,..-._Gv.T.r.,t.!.T......5 .�.��.. UNature of Repairs'or Alterations—Answer when applicable............................................................................................... --------------------•••---•-----•••••--•••--••-----•--------•-•--••----••-•-----------•••----.•---------------------------------••••-•--•----------•-----•-•-•-•----•••--.......----••-••--••-••••...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with f^ M � the provisions of • 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued Abyo of health. Signed_ ... . ... .. .-------- ----•-............--•....... T Date Application Approved By....f.r.�l�.fT .................................................. ;S�-'��04-----.-.--------- Date Application Disapproved for the following reasons:-------•---------•------•-----------•------------------------------•---------------------....---•-.......----•- -•------•-•---•---------------•----•--------•-----•-----------------•-•----------•----.......----•------•----•----------------------------------•----------------••--•-••-----•••••--••••••-----•....... Date PermitNo.................................I..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /�{/.............OF.......rJ A,N.>r . A.,P4,1! ................................ (Inrtif iratr of Tomplittnrr THIS IS TO CERTIFY,-That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by , „Installer .. I ... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Coe as describe n the application for Disposal Works Construction Permit �'ui�Q_^ I_____________________ 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 BOARD OF HEALTH N�-/3y ./ ,�L...::.; ,:........O F.... /X�,ru.�. �1 ��'" .......................... FE3.A� ... t Disposal Workii (Unutrurtiort permit Permission ' hereby granted...4e---------.S,4-4 X—-----------------------------------------------------------------------•--••-------................ k to Construct ) or Repair ) an Individual Sewage Disposal System at No.........AC r->----------------�Q-t._...CU. Ao-J- --•-•----A-b.............. ----------�fi�� ?• Street as shown on the application for Disposal Works Construction P!TJ No. _.._ .... Dated.......................................... a oard of Heal .. ........................ _ DATE....... :.._C90... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - y Aprill� I980 d 6 cry.. '�� • •. t A t., tT 3�J' x'2 r f4 a .. '!� » "+ * a, ;., ' `a a S ,i' „ �#• _ �. Yam.,. .a . To:',wt3oM T--MP Y CONCERN r ; � - .rf .�.. .N a � � 4 R.' r • w , r ��t #� ;q t .'•k .M�.e04?• This is to certify !that .the `sewe plans" for Berri3ce Realty,- Lot 7, 'South County Road, Otervlle, �h'ave , , ' been approved "by, the Board of Health. . ••� I l '9 - � Nag ., DBOARD d. HEALTH John aM. ,'. Kelly Director 'of Pub�,i6 Health T ` ' �TMK/mm � x+ � k•.. )P rz s a ��,.. � i! � �•'f. f A,j'! . 1, v • s � S _ k Y, � `G ,.. YF .. } • C•'rr � . � a- t �, w .: r �"} rYy7`^+ -. f' o a k M M .� � �,;, ti• 'Fr.' � : .'{ -s.:' y1 >. � '.� t > { ;�' y.` kh `�' r 'yS aa•. Ra" w r .r .:sir ,> ,:.1v : ° _tit, l+' t t x••. �., x•6 ay.F. ° * a+y. t { b y r Ax e.." .. F � .}, • •, ff; ,' a f,,, 7 � _ r� � '.'t�� s i.~ Li 6•°•S � `' �'. y.. �+. l e h "� 'a_ k ,I��.e l��./', + ,a•`Y y f'l # � •'4, <� r Y `, ,his _ »K No..&:= e® - Q(�Oa ................. THE COMMONWEALTH OF MASSACHUSETTS �' i<V4_ SOAR® OF HEALTH ! ....................OF........................................................................------............................... App iratiou for Uhipoii al Workii Tomtrurtiou Famit Application is hereby made for a Permit to Construct (-✓jor Repair ('�an Individual Sewage Disposal System at: 77 .5-ol�t!do.wa.Aa.............©fza�!/.�l c�........---------..............----------..•. /'' Location-Address or Lot No. .... D.SS�2 Owner .........................Address •••••zt;;�'!.�./.... ....---•--•............... Installer Address Type of Building I Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Oth dr fixtures ................................ W Design Flow.___ .L'e..........................gallons per person per day. Total daily flow------ .......................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water.___-__-__--_------_---. Test Pit No. 2----K,------minutes per inch Depth of Test Pit.................... Depth to ground water........................ . O Description of Soil------ --- --�-�S-••--�=--------�--- �.. ---�----------------•---------•-------------•-•-•--•-•-----------------•----------•-•- ? �*e.._1-- ....................... x U •-••---••••--•••--------•-•-------•-•-••-•--•••-•---•--•-----•--••-••-...--••••-•-•-•-------••-•-•-•--•---•---•---------•••••-•--•••----•-••-------•-----•---....-•-----•-----••------•-•---•-•••-•---- = . W ---•••-••-----------------------------------------••-••------•---•-•----•-------------...••----•••------•••----•--------------•--------------------.------•••-•--•--•-----••--•-•.....---•-•--•-••... UNature 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 TITMU 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 by the board of health. Sig •--•--•....................................................•-•-•.................----- •--• •.-. .. . ...-------- Da Application Approved B Date Application Dis rov or a following reasons---------------------•----------------------------------•---••---------------------------------------------...... t ......•.. - Date PermitNo.......................................................... Issued.......................... ----------------------. FizB... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.......................................................................................... Applirtttiutt for Ui,ipuiittl Vorkg Tomarurtiutt ami# Application is hereby made for a Permit to Construct or Repair (9!-* an Individual Sewage Disposal System at: , t' l e ilwr 1 .,o �� e-vY/1,%cam .........7.1__._-- ............. .................................................................................................. Location-Address or Lot No. &j4e2 - ............ ...................•----•---...................-•-- Owner Address -----�.......fi np ------------------------------------•---•--••--•--•-••-•-• ....--••••------------ --•........._...........................•-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder (. VI aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Ot r fixtures ---------------.......... -------- ,{ W Design Flow.... _-/'/M__...........................gallons per person per day. Total daily flow........ 1-4�.......................gallons. WSeptic-Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq.,ft. Seepage Pit No---------------_--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I....... .......minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2-__...(.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ D Description of Soil -� - +zp . V ....----•-----------------------------••---•---.........-•---•------------------•--...._.......-•-----------•---------------------------•--•---•----•------------------..-------------------••---------- W -------------------------- -------•-----------••-•------------......------•-•--•-------------------------------------------------------•-----------•-•-•---•------••------•---------------------....---- UNature 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 by the board of health. rSigne'd...................................................................................... ...........f......./ Application Approved By - �'l_!:....._... ��'' f --- Date Application Disapp�ved for the f ollo7¢iing reasons:---••----•---------------•------------------•---------------------------•----------•-----------------.........» Date PermitNo......................................................... Issued....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OFHEAL H ..............................O F .�`. ............................................... �rr�ifirtt�r of �uttt�littttrr �IS IS TO-CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by... A0.4 1..........-•..................... ...........•-------..-----•----•-•-------•----...----.........................--•-•--•-•-----------....----•--•-------....• at.. - <: - Installer has been installed in ac-or"da ce with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for DisposafVorks Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WIA F TION SATISFACTORY. DATE----. ...... ........... Inspector...•-' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 8 .......................................... .O F..........................•--•••---.............------............................... Disposal Workii Tuttutrttrtiutt pamit Permission is hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System s; at No.........................................................................................................................................................................;�A................. Street as shown on.the application for Disposal Works Construction Permit No.______.!f`f�Dat9j_e frc e__:_,-:-z------------------ .. F fDATE................................................................................ �/.. Boa A& Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS v ; a VOT k TI. xc. IW AI AN A UrN pot 'v i`�^L ' y r:.;�� , �i► �,r hb 1Jtlt,t'� ' �TIC- T�1� � �"'�D�-z.,, ��.aG C•,/�.; .. Zc�ew n� ; (:::— ' .• v I Law '� ' V �✓ vI i v �+1•"�fir+ �� T.F 1G.r,. 1 `^^'." Ir '� J V�� 1• M ~ .•'*y ...may y e ! UJCI O F BARNSTABLE 04('1 Ts !� LOCATION 9 SEWAGE # VII LADE ' �FI/ ASSESS fiS MAP & LO a •dOoZ " - NAME&PHONE NO. / SEPTIC TANK CAPACITY �0 lay _7C7nzt `. A LEACHING FACILITY: (type) (size) 6. NO.OF BEDROOMS BUILD OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Welland 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 a q ��� ^, 3 O�Y � 4 „: .:. ,r C/� u ��� �� � �P ay; o � `���L�f _ �� P �"�` ��� � � A r 17 E .93CA .T10N ..,: SEWAGE PERMIT NO VILLAGE I N 5 T A LLER'S MA Ill E ADDRESS ® U I L D E R OR OWNER DATE PERMIT ISSYEO DATE COMPLIANCE 15SUEp �� 60 � 31 -v LOCATION SEWAGE PERMIT NO. VILLAGE F I N S T A LLER'S NAME i . ADDRESS D UIILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUEED . +�� �� � 1 ' I/ �� , n' `~ �� � ` ,, 3 - ��� � � �� ��' _�, �osa�,� comer-a su8sooc. � 38.Z /B Jf,3 24 MED. 417 Co7�i/T Co7v/T r Sf�Nj> i Sf1nlG � l { i 27 i9�" 07. 3 /4� F A/D 7-G 2 1!5:N 0 U AJ T'E loe E'D TEST HOLE 142E5ULTS PER TO Wn/ /2ECORDS DATE . ���7n/, 23, i `J80 SCALE : 7-0 .,/N k/A TER I s ? VA / L. A 8 L E //vSP. BUILDI /VG 5ET3f30-K REQUI RE111E/VTS FR 0A/ 7- '3 O ' SIDE / S ' /EEf� ,2 / 5 ' DRI VEL./Fgy // O T "To BE LpCF-?TED P� OPOSED 13 E D20oM5 S OVE�e SE k/E .2'9C-3E SYSTEM UN.LE55 DESIGN/ FLOW S.So H-20 DES / GN LOADING /S USED - ®or'roAl-13Z.s'Adr.a �/.Y- P,eo,4=1OSED L E/9C SEPT/e Sy5 7-E M COA/ST,2UCT/ On/ SHALL C-19AIZ �c 1A:1411 CNFO ,2M T O /"If� SS ENV/,20 �/MENTi9L. PERCOL �T/O�/ TEST O • /e ES UL TS < C O ZD E Q ,D /9-r E D .TUL y 6 /y 77 /9 /D TOI./A/ OF !Fl en/S T-,490 _� HE�LTf-/ i2EGCJLAT/ ONS'. SILL ELEV. TO 3E -- FT HFOVE HE'D. TOP OF ��vAos�� T / / C A , , P R- O F / ,L E 2 % M/ti A=/AJ SHED G•elgDE lgaovE LE,,gcH FO UNDPT/onic��.$0 N O S C log L E ,9,.E/ /MPE/2VlOUS COVER � MA/VHoLEeovER To ExTEA1D To -ro P/EEVF-NT F/NES I' OF F/N/SNED GRHDE FE'OM� /NF/LTeHT/�/G MIN/MUM /O'/"f/nI/MU/v!� STONE 2 " O� j'�TO/' lO' 24"COVEe5 ��' D/ST �O �L` '�� Co;✓6,2 wASf/ED 570n/F. BOX `Iz/ h//DE f� /9ROUND 4"CAST//20M —n———mac` 3,•M/N e o ^ -Q'�� /n/. 4 D/oI. WATER ( 2. /MUM - : - — -�Y 2,.H/•�/. /GNT P/reH -��FLOW LINE ,/I/N -'-_ /FOOT /„O i'9/�l/• /4" %4"/FOOT 2 M M/' Pi TC N fC tMIAJ 14 IFOOT t WHSHED , _Y /N I/E 27 •3` 9 L F S TO A/E AL LO N G //vvE eT Pi 7S co L IAIVERT CA pp C /Ty �� f7`eO uND SE pT/C 7-fI NK .31i•G l (WATC,27_/1GH7 /NVE2T ., /A/ VEERT- L E NVE,eT "/"/.9 x I . N'O GFa,eSt9GE G/e/n/DE2 �� f�/eE�I t 20' M/�//M UM �_3. P4 D T PL ,9 AI D 5-r T;0 ^-1,/9,x 6' O Un/D k/�TE 2 ELE V. LOC AT/ ON: CE-IV7-& 2viLLE $ c '-9 E : / 3 p' DATE 2Ly / 9Bo .2 E FE,eE NC E: 8E/NG' L OT- 7 FPS SHo[-✓n/ O N A P L. f?AJ /e E C O/2 ZD E D /N THE 8/9 RAJ- ,..•- .•„ S 7F- AS L E C O U N T Y /2 E G / S T,P- y 0,1= D E E D S PLA/u COOK 339 /�'A G E 4- Fo/e s G�',�e+?Q v/eo►M r G�rUG e *�`�c3,-�(/� c o. SGf... Kt..• :J,�.._': F`�c,,,1,_u`'+�'3;J µ a ��•�4 �E /SM E PUU'T C O TF,9/NO F�o USN 1D/FA�/- - Kit: 61.tY P / O �/T ? A./,D L E� 0 HPI TCo9 lkvLEf? C H iN G P/ T S To B E Ms v- T PO/E T /`19SS . OF 10' FAO /'1 PR0PEPTy I CERT / Fy Ti1F97- THE 3 L / `/ES /9ND SEPTIC TA /VA- $,rq Ol/ o f .A-/O W N N D 4 9�y '9N D an/ 7-H•E G R O UN D f9S SHo W IV H E,eEo/�/ GEORGE / / D TN 7- / 7- �O ES C O/j FO�M �q E O" F TO L JEpow, Jk. DAT — 'TO T H E 8 U/ �. D / NG SET 8 f�C' K E Q C///eE- r 'o — /�I N T'S 0/c THE T LJ N OF 6/-> no s-T�8 ��'IsTER SURvE l�/9 T 0 19 PPR o vE D i9 G E N T iaFr .: i r I r t� 1 � i N �j rl"*7 AJ 6-E--r a 4 1 so rl 3 ` r r� -� �•t ' '� q Z o t 3 3 J PAS' :-'' �-<.•. _.. __ ll* 0 #/' i z8OG7 es ri y, i t J Foy C— FOl0L � r s ,2 i9 G C— AD