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Home My WebLink About0061 OAK RIDGE ROAD - Health LA OAK RIDGE ROObSTERVILLE 118049 i SUBSURFACE SENAGE ,DISPOSAL SYSTEM .ZNSPECTION FORM ' Address of property / �rj: R•�s e . �`�/ �'l�r��;�i Owner's, name j}rK�c�o �3arhos Date of Inspection fite y f PART A CHECKLIST Check if the 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 at least two weeks and the system has been receiving normal.. flow rates during that period. Large volumes of water have not been , introduced into the system recently or as part of this inspection. As 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. ✓ The site was inspected for signs of breakout. ✓ All system components, excluding the SAS, have been located on the site. - The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS -on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants,' if different from owner) were + provided -with information on the proper maintenance of SSDS. ce 111V . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION ' FLOW CONDITIONS If residential 3 number of bedrooms number of current residents _A10 garbage grinder, yes or no _Q laundry connected to system, yes or no Si"41/. rw.afAer ,-, No seasonal use., yes or no Ap CA,ed—✓�J If nonresidential, calculated flow: IV19 GuYrPnt : / 3�, Y3 0 Water meter readings, if available: /a-3i-53 : ' 3, /A-3'.- y,7 '• //, Last date of occupancy GENERAL INFORMATION Pumping records and sourceof information: L( / y,q e r ", GPf-sloe';/ /I4 1 ii �� 6<�ps7 /JiM NcI -FJi' IG S r 'R /A,'5 LtLclj TXP TDN✓+, System pumped as part of inspection, yes or no if es volume um y pumped r Reason for pumping: Type of system Septic tank/distribution box/soil absorption system ✓ Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: 6 It _ 124 lcaF �ir To CtJciYPr f2rv,or' recorcX Sewage odors detected when arriving at the site, yes or no J 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued. SEPTIC TANK: ANT (locate on site plan) depth elow grade• material o construction: concrete me 1 FRP other(explain) dimensions: sludge depth distance from top of ge to bottom of outlet tee .or baffle scum thickness distance from to f scum top of outlet, tee or baffle distance from ttom`' of scum bottom of outlet tee or baffle Comments: (recommends 'on for pumping, condition of i t and outlet tees or baffles, depth of quid level in relation to -outlet in t, structural integrity, evidenc of leakage, recommendations for repairs, . ) DISTRIBUTION BOX: /V (locate on site plan) th of liquid level ove outlet invert Comments: (note if level and distr' .is equal, evidence of solids carryover, evidence of leakage o or out ox, recommendation for repairs, etc.) PUMP CHAMBER: (locate on site plan) p in working order, yes or no Comments: , (note condition of pump er, dition of pumps and 'appurtenances, recommendations for maintena r. repairs,etc. ) 4 r - - 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : *h (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: e C9s Type leaching'-pits and number leaching cha r and number leaching galleries---and number leaching trenches, number-,..,length leaching fields, number, dime ions overflow cesspool, numbe Comments: (note condit *erS of soil, signs of hydraulic failure;--1,evel of ponding, condition- f vegetation, recommendations for maintenance repairs,etc. ) / `. CESSPOOLS (locate on site plan) : number and configuration depth-top of liquid to inlet invert _Al ' 7 depth of solids layer depth of scum layer dimensions of cesspool X 8 materials of construction C�/"t"`� indication of groundwater Cro�,vn �rre/ r3i�tks inflow (cesspool must be pumped as part of inspection) Comments: _ (note condition of soil, signs of hydraulic failure, level "of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) TA 1`A e 4 s r f,'vz v+�>.nfl'►S t4�ere P Y: r '000 i �n Aw"e t1i H� h,.0 /e /✓o Te e On Sn vPrT r pa S t (loca on site plan) materials of struction dimensions depth of solids Comments: (note coed-it- n of soil, signs of by is failure, - level of ponding, con ion of vegetation, recommendations fo aintenance or repairs,etc. ) -� 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM. INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' P'. ofi l�o�Si pt.� C d6 DEPTH TO GROUNDWATER depth to groundwater /3 ' !y'e%c.. 6o77o•r v� CeSSp°Ol - method of determination or approximation: 065e,-yed Level' o-( Su�'S po.,1;/ e, r e- I-f tAe i-trer-f 4zlgeeyrr To be g4a Lowerlreu y•� � w frr t�h%Sd e - 4 ors Jai ul/a;/-r/J/r "-r To..., hull., G3S r►,aPs �.e�-e vsed e✓,t7F'o. ,4, !� _ .. . i �- -e T 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined", explain why not) Backup of sewage into facility? I Discharge or ponding of effluent to the surface of the ground or surface waters? N Static liquid level in the distribution box above outlet invert? _Al Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Al Required pumping 4 times or more in the last year? number of times pumped /✓ Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: `J below the high groundwater elevation? ,41 within 50 feet of a surface water? within . 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? - within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? Al 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. 13 { SUBSURFACE SEWAGE DISPOSAL SYSTZM' INSPECTION FORM PART D , CERTIFICATION Name of Inspector To 4.1 Company Name /t'o ;(�crc/l sae SPrv 't e Company Address Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the` information 'reported is true, accurate. 'and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in ,the proper function and manitenance of on-site sewage disposal systems. Check one: I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health' and ( the environment as defined in 310 CMR 15. 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature ` � G Date Original to system owner Copies to: 5111"P 1�0 Buyer (if applicable) Approving authority L KEY NUMBER <1654 > F NAME <BARBOSA, ARAMDO > B-C 1 B-C 2 B-C 3 B-C 4 STREET 8 COPLEY STREET CITY BOSTON ST MA ZIP 02119-3123 REF 1 REF 2 PHONE ( . . ) - REF 3 REF 4 METER NO. < 1593> DATE READING _ CONS STREET <OAK, RIDGE' RD ry .._ NO. 61>. 12/31/94 , 138 /921. '� CITY OST O ST LOC 06/30/94 >' 46 -23 PHONE ( ) - 12/31/93 23 r9 06 30 93 14 , 3 ROUTE NUMBER T5 12/31/92 `. ;: 11 8 _ SERVICE DATE 03/18/55 _ 06/30/92 3. 2 METER DATE 10/11/91 12/31/91 1 6• CAPACITY 7 _ 06/30/91 0 3 -STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC X " NOTE RR LEFT BY ELEC ADDITIONAL- CONS '0' ' ALTERNATE MIN 0 Q CAPE COD - INS�EC�� Richard Davis 1230 Newtown R Cotuit, MA 0263 508-420-0260 OCT. 1 a HEpITH DEP�. tOWN Off ZAB�E LETTER OF INITIAL LEAD NON-COMPLIANCE DATE k Dear p®Ce Jc, P lT This letter_ to certify that I inspected the property located at apartment no. , and relevant common 'areas, in the city or town , for dangerous levels of lead a. - according to 105 CMR 4 60:730(A) through(F) : Procedures For Initial Inspection,Regulations for Lead Poisoning Prevention and Control, and determined that there were VIOLATIONS. The inspection was. conducted on Please be advised that Massachusetts law requires that only certain residential surfaces be free of lead paint . (Deleading must be done ;by a licenced deleader MASS. state law) NOTE: A copy of the report must be on site at the time of re-inspection which is after the deleading process . STRIP ALL WINDOW WELLS OR COVER WITH FLASHING. SEE NOTE FOR FURTHER REQUIREMENTS. DO NOT PRIME OR REPAINT UNTIL THE INSPECTOR HAS SEEN THE BUILDING. NOTE: MASS. GL CHAPTER 111 S.S . 190-199 Requires that : On both the interior and the exterior of any dwelling, loose offending paints or putty, regardless of surface or height, must be removed. The surface should then be sanded, reputtied and repainted with a non-leaded material in order to reduce further deterioration. Any chewable surface within (5) five feet of a standing surface must be stripped to the bare wood and repainted with a non- lead paint . FEDERAL LAW 24CFR Part 35 Dated 1 April 87 requires stripping be done to the (5) five foot level and as above. **. As of,.above date of regulation Sinc re y, it will be the responsibility of the owner to be: aware of any future changes in the law. Richard Davis I 1074 Inspector Licence # Report # to At the-time of inspection children under 6 were living in the house 0 YES 2'NO 0 INCONCLUSIVE BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE & BARNSTABLE,MASSACHUSETTS 02630 Phone: (508)362.2511 Es1.330 O Environmental Health 383 V - Community IWilh Nursing 332 • w Water Oualhy Analysis 337 AIA 5`J Children's Clinic Services 343 DATE: April 9, 1990 United Methodist Church 5.7 Pond Street , Osterville, MA 20655 Dear Owner: This letter is to certify that I inspected your property located at 57 Pond St. , apartment no. -- and relevant common areas, in the city or town of Os-'terVille--� for lead abatement compliance on 3/26/90 and on that date those surfaces cited in the initial inspection report of February 7, 1990'. were found to be in compliance with Massachusetts General Laws, Chapter 111 , Section 197, and 105 cmR 460.0o0 Regluations for Lead Poisoning Prevention and Control. Massachusetts law does not require the abatement of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as .there continues to be no peeling, .chipping or flaking lead paint or other accessible leaded materials and as long as covering forming an effective barrier over such paint or other leaded materials remain in place. See the reverse side of this letter for the location(s) of surfaces which were covered as an abatement . method to achieve compliance, if applicable. Sincerely, Inspector 1oo88 Registration Ilo. INSPECTION AND ABATE1IE11T HISTORY Id/A " Name and. Registration Number of Inspector Who Performed Initial Inspection Date of Reoccupancy Reinspection ?lame and Registration 1hunber of Inspector (if applicable) Who Performed Reoccupany Reinspection Name(s) and .Certification or License Ilumber(s) of Department of Labor and Industry Deleading Contractor(s) Who Performed Abatement: y