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No. !' 7-' r� r ,, - •0 Fee $50 .00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0(pprication for �Digogar *pztem Construction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) 0 Complete System ❑Individual Components
Location Address or Lot No. 567 Sea View Ave Owner's Name,Address and Tel.No. 2 0 3—4 5 4—9 6 5 0
Assessor'sMap/Parcel Osterville, MA Robert Zappi 9 Silver Brook Rd
Westport, CT 06880
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic Sry
PO Box 1089 , Centerville, MA 02632
Type of Building:
Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder tio)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic Repair to consist
of a 2000gal tank, D—Box and 8 #330 Cultex infiltrators
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 Certifi-
cate of Compliance has been issued by this Bo of alth. —
Signed Date
Application Approved by Date —2
Application Disapproved for the following reasons `
Permit No. In �'� Date Issued o9
No. ! 7� (/ r / Dry - :? Fee $50.00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.
Yes
r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS-
01ppYication for Migaar *pgtem Cougtruction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 567 Sea V i eW AVe Owner's Name,Address and Tel.No. 2 O 3—4 5 4—9 6 5 0
Osterville, MA Robert .Zappi ,,,, 9 Silver Brook.-Rd
Assessor's Map/Parcel
Westport, CT 06880
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. ,
Wm E RobinsonSAr Septic Sry
PO Box 1089, Centerville, MA 02632
Type of Building:
Dwelling No. of Bedrooms 7 Lot Size sq.ft. Garbage Grinder Oio)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures " .
Design Flow gallon per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil i sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic Repair to consist
of a 2000gal tank, D-Box and 8 #330 Cultex infiltratd)rs t
l
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction andmaintenance 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 Certifi-
cate of Compliance has been issued by this BoaEd of Ijealth. r/ V �~�3
Signed Date
Application Approved by Date . 7
Application Disapproved for the following reasons `
Permit No. 7'G b Date Issued
—————————————————=—————————— —————————#,
THE COMMONWEALTH OF MASSACHUSETTS
Zappi BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( x )Upgraded( )
Abandoned( )by Wm E Robinson Sr Septic Service
at 567 Sea View Ave, Osterville, MA has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. _7'6c,C dated .2
Installer WM E RObinson Sr Septic SrV Designer
The issuance of this ermit shall nq be.construed as a guarantee that the sys ill function as deAu- ed"'"
Date
t
-----------------------------------
No. � 7-- G Fee $5 0.0 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Zappi Migpogar 6pgtem Cott.5truction Permit
Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( )
System located at 567 Sea View Ave, Osterville, MA
by Wm E Robinson Sr Septic Service
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 pegnit. h�
Date: �-�— 9� Approved by �� / �- G
`ig'+►� TOWN OF BARNSTABLE
LOCATION 0&46 �E SEWAGE # 417 �
VILLAGE 567 Zid (/C� A-)vF ASSESSOR'S MAP& LOTZZ,4
INSTALLER'S NAME&PHONE NO. - &Q� a t,^a; 775='�774
SEPTIC TANK CAPACITY 2 000 941
SF
LEACHING FACII.ITY: (type) ''1 MA-AlMa2E(?_ (size) lyX S`L 1 Z
NO.OF BEDROOMS
BUMDER b
OR OWNER ."l �
PERMITDATE: '2�i 3�g 7 COMPLIANCE DATE: 4/41.3 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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NOTICE: This form is to be used for the repair of failed
septic systems only
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I,William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated �2 —`�"g concerning the
property located at 567 Sea View Ave, Osterville, MA meets all
of the following criteria:
• There are no wetlands within 300 feet of the proposed septic system.
* There are no private wells within 150 feet of the proposed septic system.
* The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
SIGNED DATE C-
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
(Attach a sketch plan of the proposed system Also if the
licensed installer proposes a certification
plot plan,this plan should be submitted).
LLL L "
Wm. E.Robinson, Sr. Septic Service
P.O.Bog 1089
Centerville,MA 02632
(508)775-8776
For Robert Zappi
567 Sea View Avenue
Osterville,MA 02655
Pump and fill in 2 old cesspools and install a 2000 gallon septic tank,D-Box and 7 H-20 Cultex
infiltrators in a 2' x 11'x 70'trench,equaling 809'of leaching. Requirements are 770'.
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ER 1VEEIDCommonwealth of Massachusetts
Executive Office of Environmental Affairs 1 9 1997Department of MIDEPT.Environmental Protection BARNSTA13LE
William F.Weld Trudy Coxe
Gayemor 8eenhry
Argeo Paul Celluccl David B.Struhs
Lt Caoremor CommlMbrm
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOAM
PART A -
CERTIFICATION
.SB7� v�eGl
Property Address: 567 C,a Ave,Osterville, MA AddressofOwner. Robert Zappi
Date of Inspection: 4/ —13 —4?'1 (If different) 9 Silver Brook Rd
Name of Inspector. W.E. Robinson SR 508 ) 775-8776 Westport, CT 06880
Company Name,Address and Telephone Number.
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-sites sewage disposal systems. The system:
_✓Passes
Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails `
Inepeotot's Signature: 4V Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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.
INSPECTION SUMMARY:
Check A,B, C,or D:
AJ TEM 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 evaluated are indicated below.
B] TEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indica yes,no,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 exilltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved
by the Board of Health.
(revi ed 11/03/95) 1
One Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Telephone(617)292-SSW
40 Printed on Recycled Paper
• v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 567 Seaview Ave, Osterville, , MA
Owner. Robt. Zappi
Date of Inspection: L!_ G 9
B]SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(*)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are 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) THER 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 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.
SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING 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 within 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddreee: 567 Seaview Ave, Osterville, MA
Owner. Robt Zappi
Date of Inspection: 11_�3—S r�
D] SYSTEM FAILS: . J
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 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 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
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 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. 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.
El E SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 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:
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 o r or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
require nts of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
properiyAddrem 567 5eaview Ave, Osterville, MA
owner. Robt Zappi
Date of Inspeotlon:
Check if the following have been done:
/Pumping information was requested of the owner,occupant,and Board of Health.
_one 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.
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.
The system does not receive non-sanitary or industrial waste flow
✓The site was inspected for signs of breakout.
�A11 system components,excluding the Soil Absorption System, have been located on the site.
_V&e septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or
toes,material of construction, dimensions,depth of liquid,depth of sludge, depth of scum.
ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or
apprazimated by non-intrusive methods.
, The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub.
Surface Disposal System.
a
s,
(revised 11/03/95) 4
f —
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 567 Seaview Ave, Osterville, MA
Owner. Robt Zappi
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: llons
Number of bedrooms: 7
Number of current residents:
Garbage grinder(yes or no): h.U _
Laundry connected to system or no): S
Seasonal use(yes or no):
Water meter readings, if available: 1995 4 7, 0 0 0 a a 1 s
1996 29, 000gals
Last date of occupancy: LZ�—
COMMERCIALANDUSTRIAI.:
Type of establishment:
Design flow:_gallons/day
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:
Lest date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING"RECORDS and source of information:
. /LCGv SV$e I -7 •7
System pumped as part Sf inspection: (yes or no)�L e
If yes,Volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
j/Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yea or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed if known and source of information: 'av 41 `13 d
1L'ifL - -7/ G
Sewage odors detected when arriving at the site: (yes or no) A,0
(revised 1l/03/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 567 Seaview Ave, Osterville, MA
Owner. Robt Zappi
Date of Inspection:
SEPTIC TANK l�
(locate on site plan)
Depth below grade:10 ,• //
Material of construction:Visncrete_metal_F)iP_other(e:plain)
Dimensions:
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 0
Distance from top of scum to top of outlet tee or baffle: T
Distance from bottom of scum to bottom of outlet tee or baffle: 16
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.) ti & &42 [3 a O
O E TRAP:_
(locate n site plan)
Depth low grade:
Mate ' of construction:_concrete_metal_FRP_other(ezplain)
Dime ions:
Scum we.
from top of acum to top of outlet tee or baffle:
Distance m bottom of scum to bottom of outlet tee or baffle:
Commen
(recto ndatien for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
eviden of leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 567 Seaview Ave, Osterville, MA
Owner. Robt Zappi
Date of Inspection: 41_;,-3 7
TI OR HOLDING TANK_
(locate site plan)
Depth lie:
Mate of construction:_concrete_metal_FRP_other(explain) '
Dime no:
Capaci gallons
Design gallons/day
Alarm 1:
Co nts:
(oondi ' n of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:L
(locate on site plan)
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,etc.) It, C44./
►, O`L
PUMP "AMBER:
(locate n site plan)
Pum in working order:(yes or no)
Co ta:
(note tion of pump chamber,condition of pumps and appurtenances,etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION(oontinued)
PropertyAddrew 567 Seaview Ave, Osterville, MA
Owner. Robt Zappi
Date of Inspeotion: L�—�3—'� -7
SOIL ABSORPTION 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: (npte condition of soil,signs of hydraulic fail level of ponding,
� e( ding,condition of vegetation,etcJ / /�/(e KJ s Ib et
CESSPOOLS:_
(locate on site plan)
Number and configuration:
Depth-top of ' to 1, o V L
nth p liquid Inlet Invert: v .if
Depth of solids layer.
Depth of scum layer:_ L.
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be pumped as part of inspection)
vents: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
PRIVY _
(locate site plan)
Mate ' of construction: Dimensions:
De of solids•
Co nts:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddreaw 567 Seaview Ave, OSterville, MA
Owner. Robt Zappi
Date of Inspection: L/_X 3_c)7
SKWMH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
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DEPTH TO GROUNDWATER 4 '1
Depth to groundwater
method of determination or approximation: 10', ) 45 IC
1 (revised 11/03/95) 9
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