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HomeMy WebLinkAbout0201 OST.-W.BARN. RD - Health (2) 1480 South Couht load _ ,. Osterville P d� r Town of Barnstable Geographic Information System' June 10,2014 120001011 #91 #1490 120001016 #81 M¢ WR 120001004 1480 .. 120001016 w T 120001003 096004001 #1460' 0 19 Feet DISCLAIMERS:This map is for panning purposes omy.It Is not adequate for legal Map:120 Parcel:001004 boundary deterrmnaton or regulatory imerpietadnn. Enlargements beyond a scaled Selected Parcel Owner.PANE,DEBRA J Total Assessed Value:$727400 "k _ 1'=10g'may not meet established map axzuraey standards.The parcel lines an this map O - �...z are amy graphic representations of Assessor's tax parcels.They are not true property Co-Owner. Acreage:1.00 acres, Abutters� W� E boundaries and do not represent accurate relationships to physical features on the map Location:1480 SOUTH COUNTY ROAD - sucnasWItfiingloxaaons. - - Buffer. ,... S `�- 162, COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL P—ROTECTION— �`2,O ®O I RECEIVED PARCEL JAN 0 4 2005 LOT - TOWN OF BARNSTABLE TITLE HEALTH DEPT. 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1480 South Countv Road Osterville MA 02655 Owner's Name: Paul&Melissa Valentine Owner's Address: Date of Inspection: November 23, 2004 Name of Inspector: (Please Print) James 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 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: November 29, 2004. The system inspector shall sub 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 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 determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The 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 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1480 South County Road _ Osterville. MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(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 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 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. 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: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 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 ''/z 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 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4, Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1480 South County Road- Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 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? ✓ 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 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1480 South County Road Osterville. MA Owner: Paul&Melissa Valentine Date of Inspection: November 23,2004 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: 2 Does residence have a garbage grinder(yes or no): No(per owner) 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)): 2003 215,000 gals.:2002-244,000 gals Sump Pump(yes or no): No Last date of occupancy: Current.1y occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,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 in February 2004-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 7119194-per 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: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 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: 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 zal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" 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: 14" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert There did not appear to be any signs ofleakage. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23,2004 TIGHT or HOLDING TANK: None (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/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 level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1480 South County Road Osterville, MA Owner: Paul Lc Melissa Valentine Date of Inspection: November 23, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1-6'x 6'(1000 Qal.) 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 Y of liquid on the bottom. The scum line was at the same level. There did not appear to be any signs of failure 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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 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. r�pni A e — ' e a (3 3 a 7c) a ao ao6 . 3 aS 3 ) 10 µ Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 1480 South County Road Osterville, MA Owner: Paul&Melissa Valentine Date of Inspection: November 23, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers—(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing_approximately 35'+1-to ground water at this site. Usingthe he Cie Cod Commission technical bulletin, the high groundwater adjustment for this site(MIW 29,Zone C, 10104) was 4.4'. This report has been prepared and the system 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 system, the inspection and/or this report. 11 ' BAWER & NYE, INC. Professional Land Surveyors and Civil Engineers • ' 812 Main Street •Osterville, Massachusetts 02655 Tel. (508) 428-9131 FAX(508) 428-3750 WILLIAM C. NYE, P.L.S. - President PETER SULLIVAN, P.E. -Vice President-Engineering RICHARD A. BAXTER, P.L.S. -Vice President /� b0 lit Ou SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM 4 PART D � ✓� ��'•�U '_ CERTIFICATION .•�U _�� 6 1995 Inspector : Peter Sullivan PE Location :1480 South County Road, Osterville �. Date :June 28,1995 . g � 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 maintenance of on-site sewage disposal systems. I have not found any informationy 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. Please note the summary of recommendations as presented in this form. Lastly please note 3.10CMR:15.302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be"placed upon it by the new owner. " YV,e.%truly your 0 e'Ye Sullivan PE Distribution: Original to system owner PMR Buyer SUUIVAN Board of Heath No.29733 AL MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS -------�--- -�- TOWN OF i� BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION_ - ti_-.------- �- --- -- ----^� — --- �--TYPE OR PRINT CLEARLY— PROPERTY INSPECTED - ^ (�� S CO tU STREET ADDRESS O U �l V ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME PART D - CERTIFICATION NAME OF INSPECTOR C T �2 COMPANY NAME COMPANY ADDRESS ��2- ���� �T �s-t-E&! `Ll-C M oz�ss Street Town or City State ZIP COMPANY,TELEPHONE (5M )AZG - 3 FAX (SM )42S- 37 SO CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system i 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 prop. . tion and maintenance of of site sewage disposal systems. 6OF �- PrEnR << Check one: . SULLIVAN 1� System PASSED No 29733 IST have conduct - . o'und any information The inspection which I ha � =A � which indicates that the system fails' ately 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. System FAILED* The inspection which I have conducted has found that the system fails 1 protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. ` d p Inspector Signature Date 6 2 ✓� One copy of this certification. must be provided to the OWNER, the BUYER (where applicable) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 .305 ., partd.d /3��; f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property 14eO 'vouT1A 6—STY 0�0 ) C)S� `4% LLE Owner' s name '?5Y2.t4,N 17•�c&-(7e_S j7rA` Date of Inspection v V N E 1 � t 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 3 number of bedrooms number of current, residents Uo garbage grinder, yes or no YC; laundry connected to system, yes or no �4o seasonal use, yes or no ' If nonresidential, calculated flow: Wate eter readings, if available: l��►�.�(LV� LL� �T�-QV�L� 'LAST G WkoS, 0 p 9.4 (,2,coo 34DUC f-Ii2sZ' kilos eF 95 - 33,boo - Iat6K L\ _ Last date of occupancy �C-Ct6A ROB -6y-S� 4�bti L GENERAL INFORMATION Pumping ree,cords and source of information: t�o G- I 4o System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system K_ 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: 1 eo srn f-c.C-D A Co�"A el.k A ry Lc ssU E-a u c--( v9, �99� Sewage odors detected when arriving at the site, yes or no ©si=e,4 I LL k 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B l SYSTEM INFORKATION continued I Y SEPTIC TANK: IWO �4c�—off. (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions• sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of- cutlet 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 level in relation to outlet invert, structural integrity, evil nce of leakage, recommendations for repairs, etc. ) X?-?( CW 0 F L1 Qu i fD, t A-5 MUSE IA& c�9- T-A A 3 DISTRIBUTION BOX: (locate on site plan) . Id depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) PUMP CHAMBER. ^+ (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 1't Y>v-) W U Cis TLzaq i Lc,C 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` SYSTEM INFORMATION continued I SOIL ABSORPTION SYSTEM (SAS) : y (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 ►— 1pp� GArLL-bQ leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow Cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, co dition of ve etat ' on, recommendations or maintenance or repairs,etc. ) N o <>t6K 5 D� 4-1`�D9_A L) L(_ FA4t Lu 9Z. - "D�v ,.� r- c.��•s Loves. NIC, M EG E> Tb CESSPOOLS (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 (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. ) PRIVY: (locate on site plan) � \ to materials of construction dimensions depth of solids Comments: ` (note condition •of soil, signs of hydraulic failure, - level of . ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) '- 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' EA,- -P e&1C K) 1 C... S D TH TO GROUNDWATER E� depth to* groundwater me hod of determination or approximation: , �2 P�2L77 — G eD10u i7WA Ee-\CJ 1Tl-! I F e ►. S 5&�\ INC. ENG AZ" �, e t FE-<-k-A 8 To z U 6 env bS'�Qv l-�.0: 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) 'Vb Backup of sewage into facility? Discharge or pond'ing of effluent to the surface of the ground or surface waters? Kb ' Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Q 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? .�p Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? 'V D 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? less than 100 feet but greater than 50 feet from a private water 9 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 Qrganic compounds, ammonia nitrogen and nitrate nitrogen. TOWN OF BARNSTABLE LOCATION Ly+# '�014k CU���� �04 SEWAGE # 'li,co VILLAGE, VS�f CU`� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. <<x� -77 ( - 040 SEPTIC TANK CAPACITY �, 000 y,l (01,S (size) LEACHING FACILITY:(type) �A��" Y 4iy���1��`��3 NO. 0�;:aEDROOMS PRIVATE WELL7 7 O PUBLIC WATER BUILDER.OR OWNER ¢701�/S �ci' �S C� I 0% DATE:PERMIT ISSUED: "'1 1,�7- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 Paz Pr 1 s� -sz 51NC-4-Z F4MIL-( 8E�Wx�r✓ty 40 6A�Ac�E Giz►tJnE>� -PAIL-( FLOW 3 0 ID=330 d-PD 5E?TlC TA V- 3W <1Soqo`,4qS U�e (OOP GAL ' g A-e-)L D 1 Ll F05A iw P T i- I OQD GAL,j2' STotx Pc_A�J OI.I 5I D C WdLL AREA - l 138 sf 470 6-Pv, Lo BOTTOM M2 ; `78 5g TOTX�L. 16N = 540 6M. - OrA L DAILY FI-0 Nl = ' •D !a PD;. 0�- D P-�/I E..t. 11R2coLAT1 oN OM = jlJq&",w OdA6 �R'CHaRo PETER cy 8 BAXTER w $ SUIUYAN -� No. 29733 Fey AL ENA r�s r _� TF = 4� I�o�� Iola/93 �z Qp .�.- .---�,--� -- GAL w� S7 �-¢' 1040 iu .z- X 136T rtl)l/ 4 GAL . L P�� { WNA a ' Jp1JP� 7�EP MWE T�w1J 4. VEEP t�3o si-lau. BE �-� io— L�/F1v�f PEOFI LE— LoG�rTlot t : QsT�v l 1.1.L� L>= EGA i_�% DATC— a ?•9� dos QL.AN 7eFS-r4WC" i c@z rFy TI AT TEE• FovN1�-1aTIOIJ LoT 4 S NEzr���P; � 1DWN F'�11 PELJQE- �- ° A4D 15 l-OGd'TLD IT ILI IU, 84 XYE¢ $ NYE (NC. Q��{,ID�.IdL "LAu'D SuFa/E`/AZS IIS FLA0 IS Not" ig6jZA1E+J'T' �MA1z� 5u2�e�j ArJ'D THE OFFSer, 4 40OL-D a or 'as o 5t�rzvILL / USCt) ro E-6TQY.l-ISq PtzaPetzTy 1.r�1C-S $ STD &anw. l.a dPP�tcA NT, 8ay5►b� 301a)l 1, Ccv r � bblb .. Aw - P� f ' r ° 2 -- Ile , Y r �/ I r aroa Lim 11 to � J 1,00 A� . so . coo ljTj OF k OF �4J�tHcy G �� PETER R'CHARD 4F SULLIVAN a �nxr�R M1 l� No. W33 No.2cu:e �V,FSS/pIVALE��`� � O 1 I deb. �o0r ID wcw 114So N - � � M N N 4-4 l'70 8 _ _ S0urt �vQ-r/ ILaAI�) 1-4 M5G 5005 MAT-- t20 PC-L I hereby certify that this plan has been CE.�7-/,1�=/EZ:;) �.L07- �4AA/ prepared for Roche, Carens & Oegiacomo and Fleet Mortgage. The dwelling shown hereon does not fall in a special F.E.M.A. flood ZQG,47-A5> v Lhazard area with an effective ate of 7-2-92 U -V; }- d and the location of the dwelling does conform SCA IoL�to the local zoning by-laws in effect at the JLI��E L� la� time of construction with respect to horizontal dimensional requirements . This plan was not made for recording purposes or for use in recording deed descriptions . Verification of building Lo7- locations, property line dimensions, fences or lot configuration may be accomplished only by an I- GG accurate instrument survey which may reflect (D U different information than what is shown hereon . E3AXTE�2� .VYE /�/C. For mortgage purposes only. AEG/STE.2EO L��O SU.eIiEYa- QsTE.21//.GL� r 1 � 153.34 C8 EASEMENT n�• �// 3 4-1-1 5 F n �' wl � M , n, t w 71 1' La-r 5 N N h N L oT 3 �IV N to w T f'�u,�..D 1 1►/v I LaT 4 000l ram/ SG7CJ-r-t4 Ca��Y`r1.� ������• Foi+uf�,4T7s,.1 L.ocA•no►..� OAY� c4•�.�-`14 Asse sSpQs M" 12o PA-acam' 6. I - i Z C�'.QTIF�,( "TF4JtT 77�@ FoUu�L�T+OI-! CER.T1 Fle PLOT P4,A►J S H ow r..1 r+E-{Z 6 0►.� Co►.n A�I�S w 1•t�1 QEGAuI(16/aEI.JZ'� of TaiE` 'R7WaJ of �5��*/1LLtE, MA . pA�-12�.,s-rA gt.� a>.10 1 s 1�1 crr' LGC ARc� SG�Lam' l" _ �o ' D ATE D<4••�1.2•`t 4 vj I n-," -THE a=Loo o Pam"- ¢aV. Jota 9,144 y P L A" R.a- Fs 2m"c e : kDc 1=sMr• THIs PLAU AQ oFPSEri Sr-�ow.� 9rloc�L� �lo^r• Pun- �Ax TM r2>�1 STE2� LA*j b so�Ir-i cs£. 115� TG DMT'E�.M 1 l.1 G LC�'T LuA16 S . ' MASS . A-PPLIcn�..n- : P Atisl©E �ILb11�b �.�