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HomeMy WebLinkAbout0967 SEA VIEW AVENUE - Health 9ti i aea View Avenue, ®sterville A= 1 0 L o. p) '`'' , Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS a4licatton for Mi-oaal *pe;tem Congtructton Permit Application fora Permit to Construct( )Repair( )Upgrade Q( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Co S CA,'VI Ev..) k,.)F Owner's Name,Address and Tel.No. -AZO.- 92 ZZ, Assessor's Map/Parcel 9Q6 ` Co [✓ I Eli it Installer's Name,Address,and Tel.No. Des' ner's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 1 Lot Size 0191 sq.,ArPr Garbage Grinder 14Q) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow V;y gallons. Plan Date K10\) 10. 1 J�t� Number of sheets ( Revision Date d Title '5 1 rEPL VU Peopmen sepitC— 1-5Y5rz:M C ,%gsad l&,A J Size of Septic Tank I SbU GALL D 117 S, Type of S.A.S. L EAc-k%.of G C 4k-4, A e aRS Description of Soil b—'1 „EZ ` 52q &2 COAR5-G 5A-rQ O '7 l S ```t3" 5 RZO&-6 9>0� COAa25(-S !E>Arkk 19— L04 cr C LT YE"_cx j 5 K &2 CQAr,0_S0 n 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 Certifi- cate of Compliance has been issued_b this Bo ealtt. Signed Date Application Approved by ® Date Application Disapproved r the following reaso s Permit No. Date Issued ,...;. Y •� ..r .4Y .., �^... r - sf.�"' H..b.,.....,..�.4.A. ,'�`ww•"''^^^`F+.;�.iC •r.i,+...,.n»......,,,�t'�'wJp'w',•eP'."..'^..._:. ..xL:.k .- ^s.��. ^N'o. — !.. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,, MASSACHUSETTS Yesv, 01pplication for M.k4pont *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .9 cog S C—A. V)C-v..J ko F Owner's Name,Address and Tel.No. Z�_ 9 Z ZZ- 9©1 ' z `rE�2V ILL C-- wtC �� Ave-O �1 Assessor's Map/Pazcel S E j 1 clL�f f v 14 t c. .s' Installer's Name,Address,and Tel.No. Des ner's Name,Address and Tel.No. qG `3A 4 Su t...�vP�kQ S ►ry =s?c�V6 ';0C Type of Building: � Dwelling No.of Bedrooms �J Lot Size ©1 91 sq. Garbage Grinder( (� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow 1�l3b gallons per day. Calculated daily flow 33 2 gallons. Plan Date P,�of ld, 1�`7i'� Number of sheets I Revision Date Title 5ir.Tt9L;kyU FZQ? 5E,) SEPTIC. 6Y5TZ::y-, t C X9SaU1E.vj Size of Septic Tank I SnO 6ALLO A)S Type of S.A.S. L 2l,J.uA< ,y G CKA,,LA r3E?K Description of Soil b-'l E P FWAV,-)ry COA-t2S 6 '&A4 V® ?-i S �1�, 5 mUvk)G e>zo," iU CoAdsr- SAta 19� 104 " L-r YEc(_C rSK 642 CC*H2SC (7 Nature of Repairs or Alterations(Answer when applicable) r ' r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance ofthe 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 b this Bo Healt�,. n Signed y� // Date Application Approved by 1 'd V v Application Disapproved f r the following reaso 4s r Permit No. . + Date Issued t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )b at 9GA /In -hasbeetfconstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not beconstrued as a guarantee that the sys em ilil function as designed. Date 1 _ - I Inspector -- — =---------------= =— — No. '� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS ligoml *pgtem Construction permit Permission is hereby granted to Co struct( )Repair( )Upgra e( )Abandon( ) System located at - � G4V(E-",j \) e-vt 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 permit. Date: Approved by �� %7 TOWN OF BARNSTABLE 6` LOCATION— SM- vew Ave_. SEWAGE # VILLAGE Q5 of u ti l kf- ASSESSOR'S MAP.& LOT 0 0 r 017 INSTALLER'S NAME&PHONE NO. Cc C I CAVA956R 7 qQ- 3733 SE7I7IC TANK CAPACITY 1SC�6 _ CAL, r 9 LEACHING,FACU',=: (type) Le,&;n Ckc,,Oa(—,er (size) o? ,C CA( .. NO.OF BEDROOMS BUILDER OR OWNER Doy,%-Ok O>'-yetop V►�✓� PERMTTDATE: Z�l3 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist i within 300 feet of leaching facility) Feet Furnished by /-PO " of l4ovse o0 Al- AAt- fib' i3S 3 A3- TOWN OF BARNSTABLE LOCATION &q Sew V;e,,j Ave• SEWAGE # VILLAGE 054f V; a ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. CSC I Jr Ci4V05SA SyO- 3Yn SEPTIC TANK CAPACITY lro(7 15AL- LEACHING FACILITY: (type) � CI�,�..ber (size) cp- S00 GAL . NO.OF BEDROOMS BUILDER OR OWNER PERMTIDATE: 1/ I L 2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 Furnished by f=120AJT DY I-,ov5e- . 00 AI- 17� r31 - o A3- 33' /3.3_ 3 ' + E`u�~' � .�it 'mac i- �����"k`t ^�fi"T e •-��•i, 9,.t cu �"4 ` �x ,n iy..a3s-� S tk�a�rdr tom''i =x�'-r6'�t�� 7�'FeA�.^i 5 ^+ti<r'�•..PSn,3`�.�t 7u'"An�f�l Y.i� ��5x.-rx�',u'.�� .,.�. -°'U:.,� t.. ,f�.r.�`�xa� :..�_�- ..•�.x�=�,•-�° a�o a_+�: ��-��--s c"E�`-r'«a�s.. .N _cam= -_.....��.�...�_-�._s y — ExecutivB ce ef-Er�v1�tV� iffl Affairs - _. D pa iwent 0f - 7 _ — t - L _ UjI --- =�'OB'ST3FCF - t�Y5TE1RlA5FEL'71'��QR - - Y _PART A.--' _ _ :� �' :• =J v — — - - _ CERTIFICATION P rope rty_Address. 967-se ew:Ave ostervnteMaln7House - :_ Address of-Owner Date:of_Inspe' to t9n619 _ — - . -(If different) l �� -Name of Inspector:John Gracl ` John Cooke Company Name,Address and Telephone Number: John Graci Septic inspections. P.O.Box 2119 Teaticket.MA 02536 (508)564.6813 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-site sewage disposal systems. The system: X Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 1o116196 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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:. A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate 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 ex1iltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 . Telephone(617)292-5500 1 t . r- � _.�,°� Z..�� �' �'. _.._,x - : r. _ •�,- }.fir h � � - ! -1'" ia� +ti `1'�`r.:� � '..-xz .aa�-.... c --,--_�.4Cy'�a � 't fix. ."'`,—.� csiir .s�-- �.k Y� ,� - ,r �.� - ..era-= .�-•. N - �.0 .. - - -- - _=SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - _ _ ION{conttnued) _ -- - - - Pr.operty_Address:-_967SeavieWAve."ostervilleMain House ooke . — Date�f�a tie bxfs dt a broken _ - `nb -ev+age bac�w _ ou � =sta e�naeE = -system wT pThe rs-s__Por � s _ -_-io —(- - aPPC-o lspe nfia_ r tbon box settled"or-uneven dis vaCo a oa - _ — - - = - brekerFpiPe(s.)ale replaced obstruction is-removed distribution box is leveled or replaced more than four times a year due to broken or obstructed pipe(s). The - The system required pumping the Board of Health): _ system will pass inspection if-(with approval-of _ broken pipe(s)are replaced obstruction is removed ION IS REQUIRED BY THE BOARD OF HEALTH: C] FURTHER EVALUAT _ Conditions exist which the public r evalution by the healthasafety and the en ironment�n order to determine if the system is failing to protect LTH NES THAT THE SYSTEM 1) SYSTEM WILL PASS NG IN A MANNER WH CH WILL PROTECT THE IS UNLESS BOARD OF HEA HE PUBLIC HEALTH AND NOT FUNCTION 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. SYSTEMSUPPLIER, IF APPROPRIATE) DETERM WILL FAIL UNLESS THE BOARD OF HEAL T(AND PUBLICHAT PROTECTVTHE ATER PUBL C HEALTH AND SAFETY AND THE INES 2) THAT THE SYSTEM IS FUNCTIONING IN A MANNER ENVIRONMENT: _ tic o�atributary oo a absorption waterem and supply is within 100 feet to a The system has a sep surface of water supply _ The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. _ ptic tank and soil absorption system and is within 50 feet of a private water The system has a se supply well. r analysis for coliform bacteria volatile organic compounds Indicates that the well is _ 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 free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than PPm 3) OTHER D] SYSTEM FAILS: criteria as I have determined thatthe syste violates one or more of the followng failure bas s for this determ nation isidentified be olw. The Board of Health f should be 310 CMR 15.303. The contacted to determine what will be necessary to correct the failure. ed SAS or _ Backup of sewage in facility or system component due to an overloaded or clogg cesspool. _ ng of effluent to the surface of the ground or surface waters due to an overloaded or clogged Discharge or pondi cesspool. SAS is in hydraulic failure. (revised 11115195) 2 `' .ems^. .x "�� e�,Y�''..:.,.,�.y Ja.:' .�'�, - .�;•"s.crr�3=�cn- -sc 3z.��'£�-.�.�..z- ,_f.3:::.0 1-� .e�� A'.`m�,—.- u'- -� tea. �k.:.,.,,—r �f 1 4,v ' ,.SUBSURFACE.SEWAGE DISPOSAL SYSTEM:INSPECTION FORM -;_ __ - ` CERTIFICX;lON(continued) Property.Address: 967-SeaviewAve.-.Ostervllle Main House --.-:Owner John Cooke —Static-liquid-level4n-the-distribution_box_above 4utletinvert 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). - - - Numbers 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 portiori of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ 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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 i 1 a ti t r1 i_i..-a w .S a 3:9..-tom ..c..:i. '�"r-;.�. n �`.t�.ti a��+3�H�*�'"�- r •� "� ✓�.3; � .. .."t :r�z'a h'=�•3e.._. _ d' :4.=..a-4. sue".� j� 'z_.:z%�Y_'�_a ^si r ??T` v -. S:i�'r.3.. .• r.y SUBSURFACE'SEWAGE DISPOSAL SYSTEM.INSPECTION.FORM ' 9 _^---- -- - - - - --- '-"-- -- -- - - .. _ -- - --- - - - _ - - _ - ----_� Al Property Address: 967-Seavlew Ave.Ostervllle Main House. - ourn�r: John Cooke is - -10118196= _ Date=af:Inspection.� - �� ,r Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. - X None of the system components have been pumped for at least two weeks and the 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. n1aAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System,have been located on the site. X 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. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revlsed 11115195) 4 � � r y,-cs '-a^i�� �4. 'y t e 4ZPr�t-.',ir •' y� =v ,�; -r �•ra f,t r - uf'W, .aq: �.pc'�.' '`"�•E•*a r cK a:'r*._cr s x=Tait-xk• _s•,.�..�.t �:,:.o.J.��- fl'��f �a»Y. �—^-��1::_..=. �' s�_ _�'�y', �i r�<"�.�y,i'' _C� .zs r� _�_��, _SU85URFAGESEYYAGE�LSP-05AL SYSTEM INSPECTION FORM s� •; Property;Address; 967,SeavlewAve.OstervineMalnHouse Owner; = - JohnCoake -= ° _ = - - oca a on-slt�an_)--'�:` _ _ a-�"'•r.�-"`—�-.-�-@�---•���-� _ -_ Depth below•grade:-4 __., _w— -,,.._�-•---_ -- -- - - _ -- -—- ,---__ - _ �.fvlaterial=of cons{ruction X concreate metaITFRP other(explain) _ - - =�•- - - _ •- - - -- Dimensions: L 8'6'H 5'7"-H 4'10" Sludge depth:2' Distance from top of sludge to bottom of outlet tee or baffle: 25' - Scum thickness:0 Distance from.top of scum to top of outlet tee or baffle:6' Distance form bottom of scum to bottom of outlet tee or baffle: 0 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.) Septic tank and all components are structurally sound Recommend pumping system every two years far maintenance. GREASE TRAP: (locate on site plan) Depth below grade: nla Material of construction: _concrete_metal_FRP_other(explain) Dimensions: nla Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:nla Distance from bottom of scum to bottom of outlet tee or baffle. nla 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.) nla (revised 11115195) 6 0} F^� h'};,, -•�.v.�.w.:�r..:: �.�.=�..,.x�y.�..,.L't.,.._ c-7:.�. u ,_t r:A m. � r- ss y�y .,. F .e: �SUBSU&FACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM � RaR#A-TIgN `-P_ro.perty Address:. 967 SeavlewAve.Ostervlile-Maln-House _ - - _�.urior -- - --Jafin Cooke. Date ot,lnspectlon 10116[96 - -_ RESIDENTIAL; Demon flow: 330 gallons _-- Number of bedrooms: 3— Number of current residents: 0 Garbage grinder(yes or no)`No - - Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings, if available: nla Last date of occupancy: summer use COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 .gallons/day - Grease trap present: (yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: nla Last date of occupancy: rda OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: nla TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system X 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)and source information: Septic tank and overflow Approximately 10-15 years':single cesspool 40 years Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) cJ �}'Fi 5.-iF,�r�[J!Y �'s•� -�.%-'� '^F r7."v`..•-,"'.,-iti'wr 3 g.. z:.- rP S c.k '3� 1','�:' �3' :� - -r7^ ra �:C1 r � c ..._ 12C: -'" f y t r P ..f; r' - Y_ PF _ - -_---_--STO 1 r-11IINFORMATION contlnaed �LQ✓G18LI��lLLASc• QF7 f.aaylPW-Ern`Acfnrv111n eSe _ _ _ _ = OWneP JohnCooke: `- TIGHT%OR HOLDING=TANK: - (locate on site plan) Depth below grade: n1a - Material of construction:—concrete—metal FRP_other(explain) Dimensions: n1a . Capacity: n1a gallons Design flow:'n!a gallons/day Alarm level: rVa Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no) Comments: :note condition of pump chamber, condition of pumps and appurtenances, etc.) Na 'evised 11115195) 7 J?r� � I 7:y z- SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM - r .� �. - ..ram _ - �---• _ , •-,.r SYSTEM,INFORMA_TIOPL(contlnued) --- - -�- -_- �:- -_ _ - t Propeny_4ddress.-96Zseavtew-Ave OsterrHte MalrrHouse - - - -- - - - Owrief 'John Cooke ' _ ��-,,.. �_ - - _ -- C Fish possibterFsavafren oot-r�qurr�d,batty Ee apT = - — - _ = - proxrmated by.non-tntrusrve ethods) detecmilied to tze'pres`enf, explain`_ - TyPe: ------ - 1 o pit — - - - - -- -- - - - - leaching-pits, number: ao gallon leach p - _ - - -- _ - leaching chambers, number n/a r leaching galleries, number: n/a a leaching trenches, number, length: Na r leaching fields, number, dimensions:nfa overflow cesspool, number:n/a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) r� The sas is structuraltv sound and functionin roerly.Theleach it was erntpy at the time of the inspection. l CESSPOOLS: x (locate on site plan) Number and configuration: ane Depth-top of liquid to inlet invert: empty Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: a x5, Materials of construction: block Indication of groundwater: none Na inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Single cesspool is structurally sound.Recommend pumping every two years for maintenance. PRIVY:_ (locate on site plan) Materials of construction: n/a Depth of solids: Na Dimensions: n/a Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments (revised 11115195) rt - - _ SYSTEM INFORMATION (continued) opPY eL yJ�fid 7.SeaviedrAve'Osi>?Y9711�Af�rtiFitiUs "- —_ -— ---- _ -- -- -- - OwnAr: Date of Inspection:10116196 —�-sK,EXQll-GF-SE AdGE4XSPosat—trvs - r in u>ie,iessa a least twrapeuaaaeKt=cefererlces.laudmarks-or-benchmarks D • V �� 17 .:6e DEPTH TO GROUNDWATER Depth to groundwater:8 feet method of determination or approximation: Elevation plus 2 (revised 11115195) 9 _..._�.�w_;- 'tr:::�:• �: .r.- -_•.a. ,is. �� � Ott �' ----- Commonwealth-of-Mossochusefts- _-- -- - - ----= - - - - Zz Ixe-c DW - •� —Q GE-E3t OSrAC=.SIf-.S�Efi'I�NSF-ECTION=FARAA�. y-� "-" �� -� -----PART A _ "- - - -- - — --- - - - -CERTIFICATION Property Address: 967 Seavlew Ave.Ostervllle.Cottage _ Address of Owner: Date of Inspection:10116/95 (If different) - Name of Inspector:John Gracl John Cooke Company Name, Address and Telephone Number: John Graci Septic inspections. P.O.Box 2119 TeatickeL MA 02536 (508)564.6813 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-site sewage disposal systems. The system: X Passes _ Conditionally Passes Needs Further valuation By the Local Approving Authority Fails t. Inspector's Signature: r' ;� �-X V Date: 10116196 i The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this inspections. 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: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303, Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate 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 exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 f'_ � c- tn­ • �'T�.✓!-��c�i'ET;+r .t?'.`..f�.�' , S"c d yc" '�'�S;s'Y�.E:•c i s��. "`L tit., ur. ,,,�? r�,i�.-_. .. Y,� --y _a [.� -h"S} �. L -eer a;a= '1TM3 ``"..v r e t�+}+�-.'s �� 4.Y.. �a.dr._.J r�ii'� �..,.y�r�T•--I ,r7^r s s..-r 4a,.:�p•'_ i " i^ �^_ � ^Z - €�`�+�'bT �-,� T-!+7: i.. �1 '.a�.�.��'�-�`�.i -- r � �..:.�a:a.-.':.�� - �xa'�`.:�:�:.,.r�a:ss_:.-�o.xs� -=.'`-1.-. �s ✓y,..� _ _._.2.. _ `>�...�-�.dt��-_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM " GE$TIFICATION - - _ prppartyA ress;-.g6Tseavlew-Ave.ostervilfe-Eottag -- — ---_ ---- -- - - _�" John Cooke _ Owner__ - - - - - - Date_of.laspection Sewage ba'CkAJp Or t)fee CI-DUt Of_hl h stattc water eveVo_se�eG _ g - tI1 e _ alEea - - - s em=w ijpr�val�, 8sarof Heatfb) - - broken pipe(s)are replaced - - obstruction is removed distributiontox _The system required-pumping more than four times a year due to broken-or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION 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. Z) SYSTEM THAT WILL SYSTEM IfS FUNCTIONING BOARD IN A MANNER THAT PROTECTWATER DETERMINES 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 of water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and is within a Zone 1 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 volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage in 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2 h a �` flr �LfC `•: "by-'*l'lXx`i...-y Y•?� - .., ,�' h• i'di Z �•Yf ''^#:`. _ 1 RS. {C 1 ,}-c�,G �`' ."-a, tr') L• �,� i d w {. .�- ) ,,�,... .. L-'L+ t`g7.4w•:•tl' E.. S � "ice'_: u. e+ .^. T �Ys �+z_..�-�ti w -t...._^ _u.,:._.a�._�.�-i.....r.._r� .,.s�c.�.:�...,._,::�;.„ � .^a..;,__ :-._tom. -'•,z�...._.-4� cw..:.r,-+L�._��._._ '�,.:-..�- -_ -�;�: _ �t •.--. -.�,-. .c.y- ' ._ ._..may-=----. ..a�=-,t.4-»�^n...`_'a,----_-".---_ =-.�, =:_ __ __ __ _ ..- _ _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - - - — PART A antt66ed � - - - - - Property Address: 957 Seavlew Ave.ostervllle Cottage ` Owner: John Cooke _ Date-of Inspection:10116196 tatic-liquidJpvel in the di- trib.Ldi9n box above outlet invert due to an overloaded or cloggedV 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). Numbers 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. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ The system ser.,es.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 owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 a � `arc x; -.' - .-2 - - - - -p• 'k-.,,.� �, � r ��Z{,.�. `'�Y- s'. 81r �*'�S;�Z 3"_'�-'".' S.a"'s,`"S, ti t -+: :1. c - -�,, � r E-.zt"t t- .r �' �y.Y Farr -�• ?..p<..c:.tr., .cy {. Z .n� Ma SS� FCESF�NA�E �� 6tiECLtST Prnpg�yd(95s: '967-SeavlewAve:Os>errrllleCottage __ — _ _ - = j, — -Jahn Coo a7 7- Check if the'following have been done: - — - -- -x Pumping information was requested of the owner, occupant, and Board of Health. x No of theaystem'componentskave been pumped for at least two weeks'and the 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. Nags built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. x All system components, excluding the Soil-Absorption System, have been located on the site. X 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. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) '3( tii ir'"'r t-.4 iK"` ..re'" rr. -:...' �F:� �! -. yam •�, -.y L2 ''yj�yr c. Y.c`s`. s_. Y -+_ i ,a�y _tea-' r -i.l: t`3.r �•'`- ;_ rem_ ems_ -- _SUBSURFACE SEWAGE-DISPOSAL SYSTEM_INSPECTION=FORM-_-- - Property Address: 967 seaviewAve.ostervllle cottage _- Owner: John Cooke - RESIDENTIAL: Design flow: 0 gallons um 'tredrnoms-1 - — ----------- ----- - Number of current residents: 0 Garbage grinder(yes or no): No - Laundry connected to.system(yes or no): No - Seasonal use(yes or no): Yes Water meter readings, if available: rva Last date of occupancy: summer use COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: n1a Last date of occupancy: n/a OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n!a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x 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)and source information: 40 years Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) •. f x-"l c '� 74 i. .r" T � ti,z ? i'�i 7;� !7"y.c.cs ;v" .1 1.� r � -t. � r•.'F'Y�hr'y, ff F ...-f �' c�''+,f �t .tit` -...k._�' 'x- _r •�kCtx� y...s...•�!_. - �-"'` n �� ..:;`v.�.rw-sE..._ ..� -,..,��. ss.��.,�.t.......cr;� r. _^-'�- .ate=—+^ =� _._F �•-�-P-;r"'` ��-a?:.t--Y - ,...,..rt�.�::3 - .==----r--r.� ,sue-r-1-':..z ,�- 3i�-ate.����•--Y•-T�'F=—a—'r-^ _ ,:�}-^. . P0SP.L SYSTEM INSPECTION EORM=—-- - -- ,4-�._w._� rIBSfJF�FA S � Seavlew Ave.ostervllle Cottage Fd�E$}rf66FiS _ — _ -- - - ---_ - - ,._ - John Co-�e- ---•—_ - - - sR"1 •SEPTIC TANK: ' (lesata.an-site plan) Depth below grade:n1a - - Material of construction:X concreate_metal_FRP_other(explain) - Dimensions: n!a Sludge depth:Na _ . Distance from top of sludge to bottom of outlet tee or baffle: Na Scum thickness:nla top of outlet tee or baffle:n1a Distance from top of scum to Distance form bottom of scum to bottom of outlet tee or baffle: nla Comments: f inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evik ,denceeof leaage fo pump etc.) Ingcondition ona GREASE TRAP:_ (locate on site plan) Depth below grade:N— _concrete_metal_FRP_other(explain) Material of construction: Dimensions: n!a Scum thickness:nla op of outlet tee or baffle:nla Distance from top of s Distance from bottom of scum to bottom of outlet tee or baffle: nla Comments: condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, (recommendation for pumping, evidence of leakage, etc.) nla e (revised 11115195) � 6 �i � 4 - {., r ,emu ••.,c i {. .. r n',,N•1'r r..'6 T i..:[ t.� L'. t` -, S,. Tfi _� 9�. e _.r: a �'-, 'f .S �_ e - �w� '.•4 Y YS _�:,�:.'� r; ,�. n r r � _ r =zr�.. 3 ._..F-. �� {i._ - SUBSUBFRCE_SEWAGE•.DISP-OSAL SYSTEM INSPECTION FORM — _ - Y NhINFaRMC1 Ecohltnued) _ _ — � —Pcopeat -Address_957 SeavleW Ave.ostervllle_Cottage- ----. _ .__John Cooke __`• -_ .- - -"=—Owner. -- - -- — -— - - — - - _.c- _ — - -AM -- - -TfGHT OR-ffOLDIN TANK - ----•��ate @egth Gelow grade`Na —h Y _ v.-- - -Mafenal�of construction-_concrete_metal -FRR=°t4�er(.explalq]-t- _ Dimensions: Na gallons Capacity: nla w: Na gallons/day Design flo Alarm level: n1a Comments: - (condition of inlet tee, condition of alarm and float switches, etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: nla Comments: ion is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) (note if level and distribut Na PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments:. urtanances, etc.) (note condition of pump chamber, condition of pumps and app Na I 41 { (revised 11115195) 1 7 -i i Y "'.y-' r'u', i f F J ?T fir..; a'' •.+.sw``a.,taX�-.a".-t�rl:-'T sf < ^..- �.' 4 n -So- �,•,s'yi,�=' ;ass-srT -iZ 1,�If, `t. 1 5.+- .:�Yti-L-�.:..:»��T ..�..4�1-S ^_1_7 'lY .x-�: .}t'43•""4."....d�s®J��6�.^� '� _ .T.�':_`.•""-yj...T�_`-' .C.%r.a.;��--�-,;_�' �_ _ -:-r"`2_''_.-r.,..� r _ _ '�'-- r..�• -•t�.:_I'-�v� SUBSURFACE SEWAGE QISPOSAL:SYSTEM IfJ_SPECTION."FORM — "_ PART _ rrtta� lN Fes- _ --- YS3EM ' A�7D PrgpertyAddress 967:Seavletiv_Ave OsiervllleCa(Lage LL _ - - _Ovvner.: —___Jahn Cooke._ - -Qate of_Itispecflon:-l0llBf96�----., - — - - -� - •-- - - -- -- - _ -.-- - •---- _ . --- tf=-�YB'St)Rf`t_ft?fQ-S�i.�•�E7lt' __ �—�..— �-� -- �-._,�_� _—��-g-- �—r,.-.� .�� oeate�orrste�tarl`ft••'�S3s5ibie €�a�at _n no re ulred, bu�ma � - --- __ 1f not de2ectnined to he recent exprafn "` ' -leaching pits, number nfa leaching chambers, number:nfa leaching galleries, number: nfa _ leaching trenches, number, length: nla leaching fields, number, dimensions:nfa overflow cesspool. number:nfa Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) nfa CESSPOOLS: x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert: empty Depth of solids layer: nfa Depth of scum layer: nfa Dimensions of cesspool: 6x6 Materials of construction: block Indication of groundwater: none Na inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Single cesspool is structurally sound.Recommend pum ing every two years for maintenance. PRIVY:_ (locate on site plan) Materials of construction: nfa Dimensions: n/a Depth of solids: rya Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PrivyComments (revised 11115/95) 4��r.-f-.44� ��+y�.....•..r�'�� I 1 S_i'h T�' �Z��=����a�> >t�'.- — -�_C.:.....+-- "�' -+' ,� - t ,,. p. . ,�. i r � -. �✓v s 'r �'a 2 -.'S �- .«Y�a. x 4 ` F,<., - •. .. . s^Ate. .-...{'�'. c �'�.�s.z- �.a.� a.. - ..a �-'. -'� :,.5« ....d�....,�.-. .tea^- � . 15a �-crkt'`�-�"�"-="' .,,..��:v`� Y ._- �-'_'..+-• z� v:. ux �--i:� �'�,�••-.> -i.i 3 r. .,.:f^ -Z;_ e.iPr^_5 ti x-S� _I _ __ .-SUBSUREACE--SEWAGE DIS_P_OSAt SYSTEM_INSPEC-T F-IONORM— - - - ---= 77 Property Address: g 967 Seaview Ave.Osterville Cottage - - Owner John Cooke — 4' — :Ba_tajat:dta`spacttacL include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i I I xv)j 1 l� i i DEPTH TO GROUNDWATER Depth to groundwater: 8 feet i method of determination or approximation: Elevation plus 2 (revised 11/15/95) r - Finish Grade �. Filter Fabric Compacted Fill � ca Pea Stone ti ro0o EXIST ARt # a Leaching 3/4"-1 1/2" - �'E \\ _ a Chamber - Doulbe Washed Stone () i o , I 12'-0" 000 -� / i CROSS SECTION OF CHAMBER \ A N f \ N ..:NOT TO SCALE REA 1 ' *969 PRiM O o \ — - �, O/ -Wood Fro loogo \ T.H. GI_6v, q,B o \,.. N .I St. FI cV ARSt� 1 - BROWN CO 10 o' J // d bAN D 0-13OX STRONG BROWN \ PROPOSED SEPT1� f I sr COARSE SAND ADDITION j TANK �� ISu I 967 `i'x Z2 ' , - LT, 11ELLOwISH BROWN \ / EX I ST C CAARSE SAN P EX T. 1DR1VE SHED 10y I - 387_76' GROUND WATER @ E L. 1. 1 N N HAND-AUGERED TtsST 1401-= -04/ 18/97 1�— \ Assessors Map 90 r 0 0 PLAN VIEW - `Parcel 17 DESIGN DATA fi Single Family-3 Bedroom _ to With no Garbage Grinder Scale:1' = 40 Daily Flow=110x3= 3306PD - ` Septic Tank:330 GPD x 200/0-660 GPO ,_ t Use 1500 Gallon Septic Tank Of ' LEACHING AREA n 330 GPD/0.74=446 SF Required PETER �• } t Sidewall = 2(12't 2$)2=14B S.F .. q IQ�SUI 1�LL VAN Bottom Area=12 x 25'= 300 S.F. 448 S.F.Total Provided CIVIL LEACHING CHAMBER DESIGN 14 �4a All Pipes to be Schedule 40. Use ZONES: \ 2 -500 Gal.Leaching Chambers ina 12'x25' Washed Stone Field as Shown AQUIFER PROTECTION OVERLAY DISTRICT NOTES t , I.Water Supply ForThisFLot is Municipal Water. ZONING DISTRICT: RF - 1 PP y P MINIMUMS FG.n.o AREA - 43,560 S. F. t EG.1 L O 2 Location of Utilities S1�own on This Plan Are Approx. At Least 72 Hours Prior to Any Excavation For This FRONTAGE - 20' . Project The ContractorShall Make The Required WIDTH 125' 9.1 8.1 Notification to Dig S;/fe(1-800-322-4844) FRONT SETBACK 30' SITE PLAN 8.9 t500 Gallon Top El. 9L1 1. 3. The Contractor is Required to Secure A SIDE SETBACK 15' Septic Tank 87 8.5 =8 3 Bot.E1.6.1 Permits From Town Agencies For Construction REAR REAR SETBACK 15 PROPOSED SEPTIC SYSTEM i { Defined by This Plan?' AT 1 Bedding as 5.0' 4. Install Risers as Req tiredto Within 127of Per Title , 969 SEA VIEW AVE 5 lo' 10.5, lo' 12' Finished Grade: (. FLOOD ZONES: B, A11 8c A 4 FIRM COMMUNITY PANEL OSTERV I LLE,M A 5.All Structures Buried Four Feet or More or Subject N 250001 0018 D FOR Bottom of Test Hole EL 1.1 to Vehicular Traffic`Itobe H-20 Loading. o. Ground WaterpEl. H d REVISED: JULY 2, 1992 D UNHI LL DEVE LOPMENT,CO. LTD 6. Septic System to be!Installed in Accordance With 310 CMR 15.00 Laf�est Revision And The Townof SCALE:AS SHOWN DATE: NOV. 10,19 98 DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM' ' Barnstable Boon of tibealth Regulations SULLIVAN ENGINEERING INC 7. A11.Piping to beSch. X40 PVC.- The Site is Located Within The OSTERVILLE MA Not to Scale �� 100 Year Flood Plain.