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Home My WebLink About0171 SEA VIEW AVENUE - Health 171 Sea View 4osC A= 162-022 . / Osterville 777 C- I _ 1 No. 06 tZ 357� Fee F�c� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ipiication for Vsposal �6pstem Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) []Complete System Individual Components Location Address or Lot No. Owner's I Me,Address,and Tel.No. 5oR-9 �SYVILl6! CAC-01y ��V /1�� Assessor's Map/Parcel a 60t p2 RR (( (41 Installer's Name,Address,and Tel.No.$ - q� -Z 877 Designer's N e,Address,and Tel.No. cp�Q, E✓ti��P�'�3QSj M(Z4n Esc— VV\ Type of Building: a �/ Dwelling No.of Bedrooms N� Lot Size v I 1`1 sq:-ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures A 1 Design Flow(min.required) /y gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt QQ Si DateG( - - Application Approved by Date l� Application Disapproved by Date for the following reasons Permit No. 2012- — 7J 5 Date Issued [(�r r,�1 No. , lD( J 5 Fee fflw av THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 " PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes A% .. .. Rp'lication for MisposaY ,6peffin Cartstrutfiutt 3permit Application fo'r a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. (7157 sW—V i uJ )Vte., Owner's Name,Address,and Tel.No. 5d Assessor's Map/Parcel / Q y/ (I NI Installer's Name,Address,and Te}l�.No.Sa-q 7�-g F'j 77 Designer's NaRne,Address,and Tel.No. ti i Type of Building: Dwelling No.of Bedrooms �� Lot Size` o 84-R. Garbage Grinder( ) i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /y� gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RQ_- 01 PNc i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Gornpliance has been issued by this Board of Healt QQ w Signed Date Application Approved by Date A Zo Application Disapproved by Date { Y for the following reasons Permit No. Zo(2 — 5 Date Issued /r/8'/j_n, - . _ -- ------------------------- THE COMMONWEALTH OF - - -- - - - - - - - MASSACHUSETTS Y BARNSTABLE,MASSACHUSETTS . Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by C.o� 2L v` � ►S at ilt has been constructed-in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No29QZ—354 dated t kV � Installer ey7tQ priS 425 LL('� Designer a #bedrooms 41A Approved design flow AM- gpd The issuance of this permit shall not be)c(ons/"ed as a guarantee that the system will fu no a�s d`iiygned. Date ! / `i / 1 Inspector C 1 - - - -- ----- - ----------"----•------------------------------------------------------- - - - ------ No.ZQ j Z 35 -4 �' Fee l yco THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pBtent Construction Vermit Permission is hereby granted to Construct( ) pRepair(V< Upgrade( ) Abandon( ) System located at 7 ) 5�� V P�.T 7'i V�— dCT&;ayrwg- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi _ Date l ZO 1 Z Approved by IT Barnstable Town of Barnstable %vP� AD-Ami icaCfty ;, Regulatory Services Department 1 � M F n,�n,NSTABLE., •,! "4S5. ' Public-Health Division 200 Main Street, Hyannis MA 02601 2007 ! i Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7006 0810 0000 3524 7427 November 6, 2012 Carolyn Savage , 171 Sea View Avenue Osterville, MA 02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 171 Sea View Avenue, Osterville, MA was last inspected on 10/24/2012,'by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the System"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution- box needs to be replaced You are ordered to repair/replace the above listed septic system components within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period willresult in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean,R.S., CHO Agent of the Board of Health Q:\SEPTICkonditionally passed\171;Sea View Ave Ost.doc I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ya. 171 Seaview Ave Property Address Carolyn Savage z Owner Owner's Name information is required for every Osterville MA 02655 10-24-12 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may,not be altered in any way. Please see completeness checklist at the end of the form. Important:When ng out forms A. General Information ,,,ItIllllf►�►„ on l the computer, \ OF Mqs use onk'y the tab I �:� �•�A�• sc ' 1. Inspector: ;o?: ••yam key to move your JAMES u'= cursor-do not J _ ames D. Sears - use the return =0' S-IaARg key. Name of Inspector — Capewide Enterprises, LLC *i �'F �� •o� Sn RTIF ` �y Company Name ��i�b•I N•SP�G 153 Commercial St. ��►►►nnnuulu��"``�� Company Address . " Mashpee MA " 02649 Cityrrown State , ' Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification g 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ®-.Conditionally Passes ❑ fails` ,. . ❑ Needs Further Evaluation by-the local Approving Authority 10-25-,12 a, Spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authi#hy(t o�rd r - of Health or DEP)within 30 days of completing this inspection. If the system Is,a shared-systemzor has a design flow of 10,000 gpd or greater, the inspector and the system owner,shall submit tM report to the appropriate regional office of the DEP. The original should be sedt to the systemAjner and copies sent to the buyer, if applicable, and the approving authority. N r ****This report only describes conditions at the time of inspection and under the conditions Hof 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. t5ins•11H0 Title 5 official In ctio Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary•Assessments 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name information is Osterville MA 02655 10-24-12 ?required for every page. Cityrrown State Zip Code - Date of Inspection B. Certification (cont) Inspection Summary: Check- A B,C,D or E/always�complete all of Section D a 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'Conditic nally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of.the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined, please'explain. t a Y • The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank;will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. , ❑ Y ❑ N ❑ ND(Explain below): t t5ins-11110 r Title 5 Official inspection Form--Subsurface Sewage Disposal System';Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection' Form - p , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Seaview Ave Property Address .t Carolyn Savage . Owner Owners Name information is Osterville MA y 02655 10-24-12 required for every ' page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 1 j B) System Conditionally Passes(cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven,distribution box_. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ,❑ N, ❑ ND (Explain below): ❑ obstruction'is removed ❑ Y ❑ N . ❑ ND(Explain below):' ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): Need to replace D Box t ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The " system will pass inspection if(with approval of the Board of Health): ❑ broken,pipe(s)are replaced , ❑, Y' ,❑ N ❑ ND (Explain below):' ❑ obstruction'is removed ❑ Y ❑ N ❑ ND(Explain below): 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 ora`salt marsh =: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Seaview Ave Property Address Carolyn Savage ` Owner Owner's Name information is required for every Osterville i MA, 02655 10-24-12' page. Cityrrown State Zip Code. Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in almanner 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. - . .j ❑.The system has a septic tank and SAS and the SAS is less than 100 feet but1. 50 feet.or more from a private water supply well"*.' Method used to determine distance: A **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal - to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma ,. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: ' Yes No ❑ ® Backup of sewage into facility or system,component due to overloaded or clogged SAS or cesspool Discharge or.ponding of effluent to the surface of the ground or surface waters ❑ ® due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded ® or clogged SAS or cesspool ❑ ® Liquid depth in compml is less than 6"below invert or available Volume is less than Y2 day flow P17 t5ins•11/10' Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 4 of 17 f ` , Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 171 Seaview Ave t Property Address Carolyn Savage Owner Owner's Name information is required for every Osterville MA 02655 10-24-12 page. City/Town State Zip Code Date of Inspection B. Certification (coat.) Yes ,No ` ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number ofttimes pumped: ❑ ® Any portion of the SAS, cesspool or privy�is below high ground water elevation. 0 ❑ 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with'a design flow of 2000gpd- 10,000gpd. ❑ ® 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 Systems: To be considered a large system the system must serve a facility with ay b design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or."no"to each of the following; in addition to the -questions in Section D. Yes No + ❑ ❑ .,the system is within 400 feet of a surface drinking mater supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ E the system is located in a nitrogen sensitive area(interim Wellhead.Protection Area—IWPA)or a mapped Zone I[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. • t5ins•11l10 r Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System form-Not for Voluntary Assessments 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name information is Osterville MA 02655 - 10-24-12 required for every • page. Citylrown State, Zip Code Date of Inspection 4 C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No Eli ® Pumping'information was provided by the owner,'occupant, or Board of Health El ® 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? m Have large volumes of water been introduced to the system recently or as part of El ® this inspection? ® El available 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 signsaof sewage back up? ® ❑ Was the site inspected for signs of break out? • ® ❑ Were all system components, excluding the SAS, located on site?� ' ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank ` inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has ` been determined based on: ; Existing information. For example, a plan at the Board of Health. ' El 0 ,Determined in the field (if any of the failure.criteria related to`Part,C is at issue ` approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information F , Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 4 ` 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 god x#of bedrooms): t5ins-11110 Title 5 Official InspectJoh Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 00 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name information is required for every Osteryille MA - 02655 . 10-24-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal Precast Tank D Box and Pit Number of current residents: 1 Does residence have a garbage grinder? El Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] s in Yes ®, No Laundry system inspected?. - ❑ Yes ® No . Seasonal use? e® Yes ❑ No Water meter readings, if available last 2 ears usage 2010-11,000Gal 9 ( Y 9 (9Pd)) 2011-9,000GaI Detail: • t Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: : Type of Establishment: Design flow-(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats%persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official inspection Form Subsurface Sewage.Disposal System Form-Not for VoluntaryAssessments ` 171 Seaview Ave M " Property Address - Carolyn Savage Owner Owner's Name information is required for every Osterville MA 02655 :' 10-24-12 E page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: date Other(describe below)- General Information Pumping Records: 9 Source of information: NA { 'Was system pumped as part of the inspection? + ❑ Yes ® No If yes, volume pumped: y - gallons How was quantity pumped determined?� i Reason for pumping: Type of System: t Z Septic tank, distribution box, soil absorption*system ❑ Single cesspool y ❑ Overflow cesspool Privy F Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system'owner)and a copy of latest ...:inspection of the I/A system by system operator under contract ' El Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official -inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Seaview Ave Property Address T u Carolyn Savage ` Owner Owner's Name information is required for every Osterville MA 02655 .10-24-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1987 Permit # 87- 674 .. ' Were sewage odors detected when arriving at the site? ❑ Yes .® No - Building Sewer(locate on site+plan): 29 Depth below grade: feet Material of construction: El cast iron ®40 PVC ❑other(explain): , Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): 21-1 Depth below grade: feet. Material of construction: r ® concrete ❑ metal ❑ fiberglass []..polyethylene ❑ other(explain) f Y If tank is metal, list age: • - years ;• Is age confirmed by Certificate of Compliance?(attach a copy,of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal Precast lot ' Sludge depth. t5ins•11110 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•.Page 9 of 17 Commonwealth of Massachusetts N. _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 171 Seaview Ave ' Property Address ` Carolyn Savage - Owner Owner's Name information is required for every Osterville t ' - `MA 02655 10-24-12 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) .. 2911 Distance from top of sludge to bottom of outlet tee or.baffle Scum thickness 0 12" Distance.from top of scum to top of outlet tee or baffle , Distance from bottom of scum to bottom of outlet tee or baffle 18' How were dimensions determined? Asbuilt-Tape -Sludge Judge . Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.):.. Tank and covers at 21" below grade, Tank at working-level w/inlet tee, 'outlet baffle no sign-of leakage or over loading: , 1 . Grease Trap(locate on site p(an): , Depth below grade: feet 1 . Material of construction: ❑concrete ❑ metal ❑fiberglass ❑'polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle , Date of last pumping:. Date t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M ' 171 Seaview Ave ° Property Address Carolyn Savage Owner Owner's Name information is required for every Osterville MA 02655- r 10-24-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _ M f - Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade.: Material of construction: ° ❑ concrete _❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: - - gallonsTper day Alarm present: ❑:Yes ❑ No Alarm level: Alarm;n working order: ❑ Yes ❑ No . Date of last pumping: Date Comments(condition of alarm and float switches, etc.):,, , ° a *Attach copy of current pumping contract(required). Is copy attached?. ❑ Yes ❑ No t5ins-11/10 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Insp ection ForM R Subsurface Sewage Disposal System Form-Not for Voluntary Assessments- 171 Seaview Ave - Property Address Carolyn Savage Owner owner's Name information is required for every Osterville MA 02655 10-24-12 page. Cityfrown State Zip Code, Date of Inspection D. System Information (cost.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-28" below grade w/one line out wall's are gone on box, need to replace D Box , • Pump Chamber(locate on site plan): 'k Pumps in working order. A Yes [! .No Alarms in working order. ❑ Yes [:]'No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Y Soil Absorption System'(SAS)(locate on site plan, excavation,not required): If SAS not located, explain why: t5ins•11/10 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page,12 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name information is required for every Osterville MA 62655 10-24-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits ' number: 1 ❑ Teaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: f ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: ; Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): ' Leaching is a 5' precast pit w/4' stone; Pit at 32"below grade V/cover at 20", Pit is wet stain line at 6", Wall's clean no sign of over loading, solid carry over or high stain line Cesspools'(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—,too of liquid to inlet invert Depth of solids layer .. Depth of scum layer' Dimensions of cesspool . f Materials of construction Indication of groundwater inflow M ❑ Yes ❑ No t5ins•11/10 ' Title'5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 171 Seaview Ave M Y Property Address ; Carolyn Savage Owner Owners Name information is Osterville MA 02655 10-24-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Comments(note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: ' Dimensions A Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding,'condition`of vegetation, etc.): r t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name information is Osterville `MA 02655 10-24-12 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4 • r Y F�oar ' 0. 35 R_.2: yo' H-.?= S.7 -1/7� O r Q- - $-s �J tt 3 t5ins•,11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System'•Page 15 of 17 t Commonwealth of Massachusetts ° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessmentslug ; 171 Seaview Ave Property Address Carolyn Savage , Owner Owner's Name information is required for every Osterville MA' " 02655 10-24-12 - ' page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: r El Check Slope ❑ Surface water ❑ Check cellar • x.. ❑ Shallow wells • Estimated depth to high ground water: 4fe eett ' Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans onf record If checked, date of design plan reviewed: , Date f ® Observed site(abutting,property/observation hole within .150 feet'of SAS). ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed_USGS database-explain: You must describe how you established the high ground water elevation: Lot High Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 11/10 Title 5 Official Inspection Forth:Subsurface Sewage 1isp6sal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M yt 171 Seaview Ave Property Address Carolyn Savage Owner Owner's Name F information is required for every Osterville MA 02655 10-24-12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist A ® Inspection Summary:A, B, C, D, or E checked " ® Inspection Summary D(System.Failure Criteria Applicable to All Systems)completed ® System Informatiori—Estimated depth to high groundwater . ® Sketch of Sewage,Disposal'System either drawn on page 15 or attached in separate file i . t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 � a TOWN OF BARNSTABLE LOCATION n!_ f/`e'Fw yC SEWAGE VILLAGE_ � prJ�l�� ASSESSOR'S` MAP & LOT le - 3_, INSTALLER'S NAME & PHONE-NO. ,�k w I�/�� - �yo7F a Y70 7 SEPTIC TANK CAPACITY 1, O D LEACHING FACILITY:(type) `(sizeol NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:0C, , 6 E- VARIANCE GRANTED: Yes No �• + � �� `: ti . . �1 � � �'', _ ,I j b O, "� .�, .� �� W ` � �� =' � � � � �'":. ,.., No.... Fm$............... ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -..- ------....OF.... .. ...!..4. .0......................................... , pphration for biopoii ai Works Tons rurfion 11trutit Application is hereby made for a Permit to Construct ( ) or Repair k, an In 'vidual Sewage Disposal System at: ....// ..................................... yeLocat' -Addre y , or Lot No. / Owner ress .t Installer Address UType of Building Size Lot............................Sq. feet �. Dwelling—No. of Bedrooms.__...... .................................Expansion Attic ( ) Garbage Grinder ( ) `4a Other—TYPe of Building -•--••--•-•-=-.............. No. of ersons........7.................... Showers — Cafeteria Otherfixtures ----------------•--••----•-•••. -------••--------P---.--••---••--•-•--•---•-••-••••-•------•----••-••-........-•-->-- --(-----)- W Design Flow............................................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........................................ W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test. Pit No. 2................minutes per inch ' Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------•-•----------.......................---................. 'r ODescription of Soil........................................................................................................................................................................ W U •-•--------•-••-•----••-•--•------••...------•-••--...••-•-•-••.......-••-------•-•••--•-•----------••---•••••-----••-------•------•---------- ..............................................---••-- W . . UNature of Re airs or Alt�ion —Answer when a plicable. :�_ _.__..C'_C a n A f 'v Agreeme The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with the provisions of iITLLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha4bee t d health. Sign ..-••----•--- .................... ---- Date ApplicationApproved BY•---•------� --� ......_..--••--•-•-•----•------••--•--- ................... -------•--•--- Date Application Disapproved for the following reasons:_____________________________________ .. -_-_........._ .........-•--•-------------------•----------•---...----------•---•------------------------•-•------•-•---...---•--........-------------------------•---------------------•----------------------...._.._. Date p PermitNo......9..,7.-... ..................... Issued........................................................ Date FEB .............. is THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Diopmal Work.5 Toustrurtion "pamit Application is hereby made for a Permit to Construct or Repair4l(,—) an Individual Sewage Disposal System at: I L 4111.�,....... ........ ..................................... .............. Locatir-Address- or Lot No. ..........w...........�2?..L/J.Z .......a/.... ............................................... ................................................ Owner <. ......... ....................................... ........... Its........................................... Installer Address Type of Building Size Lot___________________________Sq. feet U Dwelling—No. of Bedrooms e=--------------------------------Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons........................... Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width........_._._._. Diameter_______......._. Depth............__.. Disposal Trench—No. .................... Width.....__........_._.. Total Length.................... Total leaching area....................sq. f t. Seepage Pit No_____________________ Diameter..........._.__..._. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..................._ Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_._.._..._.........___.. 9 ............................................... ............................................................................................................. 0 Description of Soil........................................................................................................................................................................ x U ........................................................................................................................................................................................................ W ................................................................................................................. ............................................... ___ - j ------ -------------- ---------- -- -- ---- 4 .. - -------------------------------- U Nature of Repairs or Alterations—Answer when applicable._):�..'/ of ............. .........I.......... Agreemen The Vndersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IL T LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been.,ssued7, the jbpaxd ok health. ... ................... _4y............. Date Application Approved By............. ....................................... ........................................ (j Date Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................ ................................................................ Date PermitNo.---.. ...... ..... -------------------- IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH _T_ ........OF........... .......................... C1.1rdifiratr of Toutpliattre THIS IS T01 _C RTIFY, Thai age Disposal System constructed or Repaired the Individual Sew, b 2 y------------------- .......... .............................................................. ....................... 1KA, I T.J."I'll,----------------------- InstaR- Z �,'d in accordance with e-1111, op, -----------------_------ atjiu, - .1 f........ ...... "ap ..............0. has been 1 stalled dance w i the provisions of TPLIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._.._.._.._ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................lt-0..—16L--. _?............................... Inspector.................. ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA)LTH ................................ ..........OF N "? — o.... 7. FEE.... . Disposal Workis Tonotr win "pandt Permission is hereby granted..... "S.................................................................................... to Construct or Repair ( )f-arr-Individual Se-A,age,,-Disposal Systems, S at No.... 7 Street as shown on the application for Disposal Works Construction Permit No.__. Dated.......................................... ------------------------------ .................................. DATE.................. ............................... 7 Board of Health t FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS