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HomeMy WebLinkAbout0023 SOUTH STREET - Health INV "423-,ASoutWStr.,eet- 7g � Osterv�lle fl q 1L a Y� o la- +$w.+R'�m—T 44.fin.SY TOWN OF BARNSTABLE LOCATION . 1s � V SEWAGE # VILLAGE /PJ''�1 /1�1Afsi ASSESSORS MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)A&�01 L (size, NO. OF BEDROOMS BUILDER OR OWNER . A �40 PERMITDATE: 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 fe--t of leaching facility) Feet Edge of Wetland and Leaching Facility(If any % etlands exist b Y Feet within 300 fee &nty) a,Funished t Z 3 AAA- IS F , M `(0 / m I p� \ d \ flew of l4ovs- \ e TOWN OF BARNSTABLE LOCATION a3 SOC /1 ST SEWAGE # 93 VILLAGE OSYe rvrt ASSESSOR'S MAP&LOT 1-1 -Q 7 INSTALLER'S NAME&PHONE NO. .G 0 ft0rjZVft%0V J 'J&8-6 61f 0 SEPTIC TANK CAPACITY /S0QC19/' LEACHING FACILITY: (type) JeAC/f -'r e�0 (size) /8 NO.OF BEDROOMS 3 BUILDER OR OWNER ~T i M V.c M A tN PERMITDATE: COMPLIANCE DATE: ✓cb`9 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 Furnished by • ��i,�,� ads o�'�e� ��' - C`egno�t� B � • �a F a86 eA- cat TOWN OF BARNSTABLE LOCA 11ON �-� S `f SEWAGE # PILLAGE O 5/ ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) k NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: j® COMPLIANCE DATE: 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 Furnished by 69e-MCX— o -77 � v5X i _ sT" h a� ��W _ -- 3�o-tbk f 3r �a . Lib i w yo 1 ►4T �( - cl F$s..... ....._..... _ \ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF •BARNSTABLE Appliration for Di-rip iul. Workii Tomitrurtiutt Permit Application is hereby made for,a'Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: 23 Gov i� s� OSi '2vit �/� .................._..........................................------------...._..•. .....................................------------........................................... //_,7 O/ �a' n- ddress �' ) or Lot No. ......................-------......,.......................----...-•-••-•--•----•-•-••-••------- -•-----•---•---................._............----•-•-•.........--------------------............... Owner Address a ................. .... .................. ........................................ ��r Address Type of Building Size Lot...3Sv.........Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other;Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other tures -----------------•...--- -- W Design Flow . ................................gallons per person per day. Total daily flow............................................gallons. Ix Septic Tank—Liquid capacitv.�5O0gallons Length................ Width................ Diameter................ Depth................. Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.:17_1`b....sq. ft. .-Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z {'.J" Other Distribution box ( � Dosing tank ( ) Percolation Test Results Performed by.....,..a4� ... .���!........��� Date.... �. .�. ....... Test Pit No. I................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....._.................. -------------------------------------•--•--.........---.................................................--------................--•-.....................-•-- O- Description of Soil.....,............... ......... � ........................ .a te.... !:: F__ /L7'�' S/J O .... A ........... GCS J Cac �`� U; Nature of Repairs or Alterations—Answer when applicable................. .............................................................................. �✓C� Gam..... ?poQ S..._.7� %Lam__.. �.................. -------------------�P n4l. ----T'------•..... Agreement: The undersigned agrees to install the aforedescribed Tndividual Sewage Disposal System in accordance with ►t the provisions of JIT%i� 5 of the State Sanitary Code — The undersign undersignod further agrees not to place the system in operation until a Certificate of Compliance has b3 - issue the b - health. Signed Z �� _ ........................................ ................................ Date r'A lication Approved B .. ........................................... ...---c. .�. �.�-9• •...-- PP PP Y 1 Date " i�Lion DimDroyzed for the /I TOWN OF BARNSTABLE LOCATION a3 Sor;fn ST SEWAGE # Q VILLA OSY-wyt ASSESSOR'S MAP & LOT "I - INSTALLER'S NAME&PHONE NO. GOMN��M APACITY SEPTIC TANK C dQG9 ' ►— t LEACHING FACILITY: (type) P/�C H �`i e h (size) X" NO.OF BEDROOMS 3 BUII,DER OR OWNER I M I aS M A vV (� / PERMIT DATE: l S COMPLIANCE DATE: % ~�b`9 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 Furnished by 10 • , tco�• ,9,C 1 v Z oZ° f DATE: 2/25/0 PROPERTY ADDRESS: 23 South Street ' Osterville,Mass.----------------- 02655 On the above date, I inspected the 'sept.ic system at the ab9ss. This system consists of the following; r 1 . 1 -1 500 gallon septic tank. MAR 0 7 2002 2 . 1 -Distribution box. 3 . . 1 -20 'X24 ' leaching field. r TOWN OF BARNSTABLE HEALTH DEPT. Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. 5 . The septic system is in proper working order at the present time. _ 6 . Dug down to and into the field. The tones are presently -dry. 7 . Pumped the septic tank at -time of inspection. SIGNATURE:s` Name:-J . p . Macomber Jr Company: Joseph-P. Macomber-& Son , Inc . Address Box 66 Centerville ,,_ Ma . 02632-0066 Phone: 508-775-3338 p THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachffolds rt Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 s COMMONWEALTH F �lY1,{��AL H 0 ti,�SACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5' OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 23 South Street Osterville,Mass_ Owner's Name:Sl7P Ki ngman Owner's Address: 29 South Street ns'f-Pryi 1 1 P'NtaRG _. �. Date of Inspection: 2.42 514 n 2 Name of Inspector: (please print) Joseph P.Maeomher Jr. Company Name: ,T_P_Ma nnmht-r R, Snn Inc. Mailing Address:gnx 65 . 02632 Telephone Number: 5fi 0 -775—'� "�R - CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DE approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: APasses _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails G Inspector's Signature: Date: The system inspector shall mit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.if the.system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP..The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ••*• a time of ins ection and under the conditions of use at that This report Daly describes condtttons at tb p time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Titic 5 Inspection Form 6/152000 page I Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) IF Property Address: 23 South Street Osterville,Mass. Owner: Sue Kingman + Date of Inspection: 2 2 5 0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: D I have not found any iexist. tion hich indicates that any of the failure criteria described in 310 CMR 15.303�or in R 1 Any failure criteria not evaluated are indicated below. ' Comments: ' The septic system is in proper working order at the present time—.. - B. System Conditionally Passes: 4A& One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement.or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally, unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. E ' ND explain: 4 /Uy Observation of sewage backup or break out or high static water level in the distribution*box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with,- approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: �— The system required pumping more than 4 times a year due to broken or obstructed"pipe(s).The system will pass inspection if(with approval of the Board of Health): ' r broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM,- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 23 South Street Osterville,Mass. Owner: Sue Kingman Date of Inspection: _2/2 5/0 2 C. Further Evaluation is Required by the Board of Health: , NO 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(l)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: VO The system has a septic tank and soil absorption system (SAS)and the SAS is within 10..0 feet of a surface water supply or tributary to a surface water supply. VO The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. Xlb The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. /(� The system has a septic tank and SAS and the SAS is less than 100 feet but 0 feet or more from a private water supply well". Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.. 3. Other: .f�il.CJ�'✓ , 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 'CERTIFICATION(continued) r Property Address: 23 South Street Ostervi e,Mass., Owner: Sue Kingman , Date of Inspection: 2 2 5 0 2 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the following for all inspections: Yes No ckup 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 ,0 A.t�' '4 C Di`Y 7 _ squid depth in sess}�eal is less than 6"below invert or available volume is less than 'h day flow �equired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped'JL RANJ'.OA ' y portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _�Any portion of a cesspool or privy is within a Zone 1 of a public well. _ � y portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,- performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the.system fails. The system owner should contact the Board of Health to determine what"will be necessary to correct the failure. E. Large Systems: r To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to I5,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in-addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply r _ !✓ the system is within'200 feet of a tributary to a surface drinking water supply �/ z _ !/ the system is located in a nitrogen sensitive area(I;nterim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 _- Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:23 South Street Osterville,Mass. Owner: Sue Kingman Date of Inspection: 2/2 5/0 2 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes Nopumping information was provided by the owner, occupant, or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period? — Have large volumes of water been introduced to the system recently or as part of this inspection? -ZWere as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up Was the site inspected for signs'of break out? Were a]I system componentts Aluding the SAS, located on site? _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum ? — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes d _ Existing information. For example;a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C., SYSTEM INFORMATION Property Address: 23 South Street Osterville,Mass. Owner: Sue KInctman Date of Inspection: 2/2 5 f 0 2 FLOW CONDITIONS - - RESIDENTIAL Y . Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): Number of current residents:&&Z Does residence have a garbage grinder(yes or no):.G�'. Is laundry on a separate sewage system(yetor no):,( [if yes separate inspection required] ` Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)):2 0 0 0—9 7, 0 0 0 ga l l ons=2 6 5.7 6 GPD Sump pump(yes or no): -UCH 2001 -95, 000 gallons=260. 28 GPD Last date of occupancy: AlJ�- COMMERCIAL/INDUSTRIAL ' Type of establishment: Design flow(based on 310 CMR 15.203): A14 gpd . Basis of design flow(seats/persons/sgft,etc.): eo Grease trap present(yes or no): Industrial waste holding tank present(yes or no):.JL/9 Non-sanitary waste discharged to the Title 5 system(yes or no):/11y9 Water meter readings, if available:_ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: IMe& ,.y - Was system pumped as part of the inspection(yes or no): i $ If yes, volume pumped: w_6 gallons--,How was quantity pumped etermined?/ V/%?4 Reason for pumping: 0A ry V TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Z6 Single cesspool , ,Vj Overflow cesspool r $ .?. Privy Shared system(yes or no)'(if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained.from system_ owner) ,ee Tight tank .l,L� Attach a copy of the DEP approval 4 Other(describe): App imat age of all components,date installed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):o" 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:23 South Street Os ervi e,Mass. Owner: Sue Kingman Date of Inspection: 2 2 5 0 2 BUILDING SEWER(locate on site plan) , Depth below grade: Materials of construction:_cast iron Z0 PVC 46other(explain): -e1` Distance from private water supply well or suction line: !4 i` Comments(on condition of joints, venting,evidence of leakage,etc.): Joints appear tight No evidence of leakage The system is vented through the house vents. SEPTIC TANK: (locate on site plan)���d��'��'��� Depth below grade: 1'1f JJ Material of construction: concrete e netal fiberglass polyethylene ,Vj_other(explain) eeld If tank is metal list age:" Is age confirmed by a Certificate.of Compliance(yes or no):.</ (attach a copy of certificate) Dimensions: 1116` i'G' Sludge depth: e� Distance from top f sludge to bottom of outlet tee or baffle:,4_e_ � 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: How were dimensions determined: rdi Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of.leakage,etc.): _ ' Pumr2 the s nt; r tank every 3 Inlet & outlet tees are in place.The tank is str &t ura 1 1 y sound and shows nn eyl rlennp of leakage.The liquid level the outlet invert 'is fifty one inches. GREASE TRAP6eJL(locate on site plan) Depth below grade: ,�X Material of construction: concrete/ metah/�fiberglass�olyethyleneit, other (explain)_ 141� 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: ,�r9 Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet-invert,evidence,of leakage,etc.): Grease trap is not present; 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 South Street Osterville,Mass., Owner: _Sue Kingman Date of Inspection: 2/2 5/0 2 TIGHT or HOLDING TANKq/we(tank must be pumped at time of inspection)(locate on site plan) . y Depth below grade: V4 ' Material of construction: / concrete tO metal.d/A fiberglass �i9 polyethylene 40other(explain): A,IX Dimensions: ,lJiO Capacity: p ry: allons , Design Flow: QUA gallons/day Alarm present(yes or no): Alarm level: _ tV� Alarm in working order(yes or no): v9 Date of last pumping: Comments(condition of alarm and float switches,etc.): Tight or holdir-g( tanks are not present 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.): Distribution box has four 1 atera 1 S_ Nn Pvi dpnrp of solids carry_ over-No Pvi dlannp of leakage into nr oiat of .the lcnx PUMP CHAMBERe rJe,(locate on site plan) _ Pumps in working order(yes or no): f� Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber is not present. l 8 Page 9 of 1 1 , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 23 South Street Osterville,Mass. Owner: Sue Kingman Date of Inspection:2 25 02 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan,excavation not required) 20 'X24 ' Leaching field If SAS not located explain why: Located. See page 10 Type 4,�6 leaching pits, number: leaching chambers, number: ` 11 leaching galleries,number: aching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, number: Q— innovative/alternative system, Type/name of technology:,r0 fjye. -Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand.No signs of hydraulic failure or ponding. Leachfield is presently dry Soils are dry vegetation is normal . CESSPOOL�(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: - Dimensions of cesspool:' ' Materials of construction: 4Z Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): SGpool- arc- not pr _s nt- PRIVY�/�(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.); Privy is not present. 9 Pagc 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: 23 South Street s t ervi e, Owner: Sue Kingman Date of lnspecdoo: 2 25 02 SKETCH OF SEWACE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or Dcnch.mvks. Locate all wells within 100 feet. Locate where public water supply enters the building. • � o Sk-e r� Via a, ti r \ Jo. - \ 1s> 10 Page 1 I of 1 l OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued)' Property Address: 23 South Street ' Osterville,Mass. Owner: Sue Kin man Date of Inspection: 2 25/02 , SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water feet - Please indicate(check)all methods used to determine the high ground water elevation: Obtained from s ste deli s on record- If checked, date of design plan reviewed: - Observed site abutting;prop�ebservation hole within 150 feet of SAS) hecked with loca Boaoth-explain: hecked withlocal excavators, install (a ach documentation) Accessed USGS database-explain: !i You must describe how you established the high-ground water elevation: Used; Gahrety & Miller Model.Groundwater contour elevation above sea level. 12/16/94 Used; Observation well data_ June 1992 Used; USGSTAnnual ranges cif grc)unr7 wat-r�r g?_Qp0_1 Plate#2 run ow 'eet Groundwater j Feet Below Bottom*of Pit- High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the bottom Of the leaching pit and the adjusted groundwater table isi� feet. 11 w S I`, rrnn.r•nrrs�.-n—err'-m.•rrmro-nr.ae*rrrar:-n++•:►mr:nrrernrmm�ar+s�r+ar,rr� - , .�, TOWN OF Barnstable BOARD OF HE.ALTII . 31H)SURFACR SEWA(;F DISPOSAL SYSTEM INSPECTION FORM - PART D.•- CERTIFICATION I rr7^r•.-•.•r--.,,r.^.e--nrrm•rtrrtr�irastrrtTnrz��mr.�arntve—T'rn*+evn+►�s�aes e�nt� ..�rrr-•r•„ .—..A -TYPL OR PRINT CLEARLY- . + PROPERTY I NSPDC7'E'D '. STREET ADDRESS 23 South Street Osterville Mass. ­ ASSESSORSr MAP, DLOCK AND PARCEL # -_ �!7 7� OWNER' S NAME Sue Kingman PART D., - CERTIFICATION Y NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Incr! a �. , Y COMPANY ADDRESS Box 66 Centerville Mass. 02632 Strevt Town or City state LIP COMPANY TELEPHONE �08` ) . 775 - 3338 FAX { 508 ) 790 - 1 578 R a CERTIFICATION STATEMENT ' I `certify that I have .personally, inspected5the sewage disposaj system at this address and that the information reported is true , accurate , and omplete as of the time of ,i'nspectlon . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and'experience in the proper function and maintenance of on- site sewage disposal systems . Check one ; , System PASSED The inspection which I have conducted has ,not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure p criteria not evaluated are as stated in the' FAILURE CRITERIA section of this form . v System FAILED* F` \ The inspectionnwlick I have conticted has found that the system fails to p'ro'tect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this "inspect.ion form . Inspector. Signature r Date z.—s^. .... anecopyofthis. at. fication must be provided. to the OWNER, the BUYER here •applicable and the, DOARD OF HEAL7111. If the inspection FAILED, the owner or operator shall upgrade ' the eyetem within one year of the date of the inspection , unless allowed or r. quire ? otherwise, as provided in 3.10 CMR 16 . 305 . yFart ! I n/ y TOWN OF BARNSTABLE I.00'ATION A ��� V//' 'isT� SEWAGE # _ VILLAGE ASSESSOR'S MAP do LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)��LdJC�lGe I NO.OF BEDROOMS BUILDER OR OWNER,, i/® -- �/I� PERMITDATE: 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 PP Y Feet on site or within 200 fect of leaching facility) Edge of Wetland and Leaching Facility(If any%etlands exist within 300 fee lea• Qx) Feet Furnished b o h �►�% / � -IV ' 110_ f 2y� TOWN OF BARNSTABLE LOG,A-hON a3 SOCIAj ST . SEWAGE # VILLAGE OSYe ry�t P. ASSESSOR'S MAP& LOT I 1 -® 71 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACEL=: (type) 1 eACtt a�0 (size) /8 t t 14 NO.OF BEDROOMS 3 BUILDER OR OWNER_—rim c M la V1i PERM TDATE: 915" COMPLIANCE DATE: / —c26_9�r 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 Furnished by A G b �- CA 0?8 37 TOWN OF BARNSTABLE L0CA-hON Z-3 S `� `S J^ SEWAGE# "JII.LAGE d_S7-� Voe`-� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: /!?Z COMPLIANCE DATE: 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 Furnished by � �� Z 3 S O cJ i�`_-�� � . M I SELVER PIPE FROM Zg575raE OP• 15 EAJ TER Ea d PF 7A.v'l�, rt;o,^*I u5s T 5,;ZN'0 F N•oU-SE /5 Tb ENTER 31DE'4F- TA,.,,K A/,/,D ExT�rlJD /NsIDE TO CF^/ t��', OP • ,,�� d.4„ r5L0FIE, F/'L A��>>�'r FP;oM CouEEA) � J 611 IE CL C/'7/�J' `'C K�� i` it ! a. I''r!i 1V ' '�.'r C'7[.'/ '• _ .- -- ___. _ ... i .q 5CH. 40- PVC I — ----- . _ _-�._.�___..._ _____ ._—___.._._.-�—. ____. - ----__ LIQ�!,p_L EVES. __ _ _---__ __ SL OPE l t'R FT (M!N•�' l4 �5 Lb. 93, ' 44 �ryF F3�'1� �' � �4 - -,----•- - .,___________-__- -_ - f_ - '` —.� `. S.00IL ; `�--- q�; EX� ! 44.70 5 0P : l /6" r clo € 4�,_T3 T, ,..- I{a r I I N I n ALL D. n.1:X' 4U;LE•,� TD flT EX� SLY 4B "94,94 /SGO GAL . i T,yE S�!.'-16 EL E'✓fJ 7/OA SEPTIC TF,fiJK SEE 1-A47-e g 3 ! { fi SYSTEM PROFILE ,?r- !�-,(CAV 4T/0N ri.,= / 38.4 t + WALE : i" s 3' 3 6 , /.v E ED r rG WA SNtn S TO,VE ... ..._ ___ =°`�._..__ ter. 1. -Y.:- ;, .r:�- ,fi-- . . - .: -? :-;. _: : .:. .. T• GF Pam: LEV 43, 94 6" aU rh 5 ;.}, E- T - CIS'1 /4,l!^TE �3 90 .4 PP rN nxjMRTE- T3. r-Crq OF EXl�3!i�47'1e,,C E4e'V, 3Fs q t BENCH MR K: ,, r, ,n :. . •� SOUTH EH,ST ��kr✓ RF-�- _4 SCti.4D ;� a r3� :i s..tv •L,ti`_r rF ara rT^r�+ F.�Ak, ,' 40"'A'I D. Latin ,r TYPICAL CROSS SECTION i �TEF ELEV. SC.4G' i i 4 SCALE : r = 3, 9' L�'L 48 t R,4 D. L! :'G EX 15'"?I ra G RG�t�.d.'v EL Eb. 4 7.4 /o' - 3 aE, � ,�r svascll �. NOTES Br35Er�if-VT FL.E1.46.9 PENCOL ?�/ON R4 TE / /-I il,%, ,�'E� l/'1CH ,FV5rbV6 CEsSP �� -- �- ,] P DV, EL 54.r 5 C.I. u EJ, 3/!, ,;' ( r AG TO BE f�B�?Nf�!!,'E7� � � ^� I DE�,�SE I � � f'r^C'�LATI e�t.1 RATE �;, .. . / ► I 1 I v �. DE�!�N FLU ��/ 44C, -5,,4L . P,ER DAY . �4 PYDR,0'1MS� SILT Y 15006 tL. SEP'llL 7,AljK I € 1 it I 3 , Lx-hCH!1, 6v jREA - 'f40 S. F 4AkG 4, TICr`/ 7-E.5775 PFN*PrO R 1v7 1=D ,BY EDW,4RD H. wMJ61,1AN RF . DA j'-F 0 T-FS Ts Nc , SET" Pt f '"sAME DR'�. f 47 5. TH/5 5Y "YM A�-T r ,-. FDR 0,5 a pt cs?' I , � r \ ": ._�; � � CF 6f 0,4,6 GRINDER. r,. �a,v;. , t( ����laz ;,. 6. ,ti'G� u! LL eR w'rl VDs w! rM/A/ /rC, F7; GF5YST"E'N?. CO!!B to E € € _ 8,4 7, 5 T t�UC !O,t 77:� �^ �? ;°rf; T 1F Le I r"i 'M,F 1�,T;, OF T` ''L E- II f . ,,� CL kt'tt' T/l E 1 c o/= D or N Cf)1 'H -- \� � �\. ' CGU!�'S `=! ( 8. ALL GE:�ISE . !L TY -SA�'1I� ,+,ac ,°.3L 1 T !; 9c FRo;A7 l�!lTMIi+J 7h'E - € T'ry G� .r A%!G �G�t�:�",,I 7"!r TN Tr�!= CF Tff 6- CL E.qN Co�'K'. Ty/S SPACt' 116 7-0 E i ` ^^` 7-5D %U "7'' Jr, A55 ESSo.fi 5 PL A7' /l 7 Cef .;� � � L' € Ado WATER 34.4 Z-AYERS l:'P TD T,yE G/= THE I3vT?' %7f} GF 7HE' SEC.) K/I JH A 3 - _24 '_ �' ! _ JAN- /'7AR. 19 95 COG F;` E' Cf ' 9,4 1 , Ati'D Dfi £�R'f JEL ,'J ';f r.t/C, r9/t; l t�'-/'1.A re PEJ�CC L,�I 710A' LC 7) Rf67'E rF Z MIA/, n_ N LESS INCH . LGT RREA 1o3b-o 5.F. -• � \ ' 1 SOIL PROFILE -- �; REPAIR SANITARY SYSTEM OF Fy`W {3 NOTE TO APPROVING AUTHORITY =— � 23 SOUTH STREET OSTERVLLE. MASS. S11VC-i THE V,6W,'E Sl' TY SAAID i"lAT"E�iAL THAT IS TD G SCALE: Awaaveoar: o�A er r �r l �a r �r+ p .9 5 S Nbki/!J PLAN RE1`7ovE,D HAS 4 SRC Rio r�li' 24M.Fl. /T J'.5 /JO7- C��A1���ERE':a � �,. DATE: //"►Pt r�V/CU-5 5� ' T! TLE 2- 7"HEFkEFORF A /a Fr ©Ve-R,,D15 4-5 er��1 T2 6, *� .�f,Y WWARD H. KINGMAN P.E t� �' '�" " °c� G.�sr�' ��4` 'MISTERED PROFESSIONAL ENGINEER SCALE : 1" = 20' NOT RE'Q Ll I R t D. F'L Ei4>E REFER TD . CO,�..;7W OL-1, /cON 14V FILL. �; AL .<% - R"SUMMER STREET, REHOBOTH, MASS. 42769 SEC. /S:a e (/7) Ait/D `E�C.'JL A Ti c�f/ TES�7' , SEC, I S,,03(4)� 7 uaAwlN(3 rNNMSER rTEM /Vo. 5 U�VOER f t! „� T,;�$i E D�•L fAGHtiV� AR�,9 RE"Q i.1!R�./"1,Eitl T.S. ,�/,,� ✓ ' ak r 9Et/FR P►PC FROM ZA5 i 51:0E'OF' { Y," ;F /,5 }n EAJTER E,vD PF 74AI f, 5�i�/ER, PI PE F;R�,�1 r�✓EST ��D M'G F Ito/5E l5 To Fl"IrE .s1©� AND FXTEAID 111151DE TQ O • ,, rA A/x.. BOTH 1/UJL rT TE57s ,-o s E- ,s/&E =� B r nE � CC�5 ro 1?_ _S"� H.`E� PE Fr CCA pE' M 196,11 S -� c- i r,SL O L L ,9!/,'r?Y FROM CO UE, •- - F"X15r,�.�� GR<�1� - - �, 10' ro s,ct GF Tf/R`k" CL E�iitl �r K L l D)cTF';ill;c�a,�1 �JX / )n! 1 -- 4 ,5CH •40- PVC' M r • � 2 TH/CKit1E55 4"Sf�R-35 SLOPE 4 � Fr j i t-_ _--- P NMI map LIQtJtp 14 • _ �j' 49.70 45.00 I 4"5DR-3.5" PER Fn�,,RTEJ P!QE I - 44•g4 SLC7{'k' ALL D,uoX 4)C%E7,; To3EAT �X4C7"L;'� r 48 . " 6 THE SA•Me EL 5 W3 7-1 ON SEP?1 C TANK I SYSTEM PROFILE SCALE r '■ 3 _ FIA115N Tl 1 G Aof 24 a" 7-0 r ''G G/A SNP n To�t/E 2' r^,tN, THIC1tti1��; e _.T :.--- .... ,.r. -- ,�•,,. .- - _sue.. `, 4 50R- 1 P1:C PE '1C/9 TED P1 PE SOUTH T:� E \. , S EL iV0 TE' 8 1VL E N0.3 ----- --- ;s fiF1�R�X1/'?!f7"E 64TT'G,*-1 OF EXCAVAT/D,u ELEI/. 3Zp.4 ± BENCH /"LARK; SOUTH "S T 6*6W 'R - ,� 4''SGM. 40 7-0 PAC E,?.°JLf*.�,1�'= er' srT7%,4*1 01Y.C. TYPICAL CROSS SECTION STEP El.EV.. 50.40 _f._ � 5,1wFEP4 BEND f8 i.. �, � SCALE : !" = 3' ' HO�ISE Ar. 23 h „RA J. L ,EX 1 e T7f�'/'a C;,�GC%-��`� EL.FV.._`.�7.4 EZT?AV 4"C,I. 4s3 r f 4�0 — � ( TDPSO!L 3 B�VR001ft715 sugsori- NOTES : 5A5EMENT fL.E.46,9 _4- •/O• TOP FDN. Ft. 59.15 4 C.I, �Jci I f��©. G�L/9TIC�.11R 7'E Z1 f�GH q arc � ` DENSE .P �`` SILTY +_^'J 1=L0 tom' 4-f�� 6,4L , P,F'R DAl' (�4 BEE' 0'? 'f � ! � � i l `..� � 13 . R c a U;RED ' Eft CN!lE.r`•., -� 4. L,=3 T, TES .5 ;B Y ED VA RD H. W1 J 0A7-F OP' T"EST5 /VOV. is 1.9 94- SET" Pip SAME �r i 1 GRGEivD b/9 i E)::� 08.rERV4TI0Al3 7114RV J91e1- S. :rH 15 S YS _rLr M /i G T K:E`S!Ci i i,�L? FCC Fc L%;E G F G r G No �1Ec l s d t k1 C TL/4 'V n 5 ��1/ 7-H l A/ le-7 F T, OF s Y r S C4.,E,4,V e 1 •+ �i '�--1__ -� \ �� �� \ � . . � � 7714 b L.c1 C,H L ��F NF,91 T h`. � 6. ALL l?ENS E 6!� 7-Y �r4/r,�`� >'t;'t?i',�=F�•,'x?�:. I 6 T,.. f s:� S 1 SR��U f D1r'!E/iS�G',!' Cif`' 7'1-' BoF= /W D C>011,4V TG T°Hir Y<-iP 47P AAILO. 77/H i 5 -5 PA C E /S 7`0 3 c 1=!L L S* f AID �0/�`iF�'� :?`E'• ' � NO WATER 34•4 LA YER 5 L;P rO THE FL E V.t 71 -Al` GF• THr 5C T r(f),-'? CF TNw 1/7 ____ 3 24 ,,, f 1 4 J�?N- I'111R. 19 95 C�{_i/' E CL crf, / SAAJO 0?;' 6A' ,VE<. N.�r"Vrall Ati' /.(.r�ML-.4r"E' i J; 719 Or 2 /`'!liv. e71; LESS 1-IFR 1/VCM, . 3 F. SOIL PROFILE REPAIR SANITARY SY T { *. NOTE TO APPROVING AUTHORITY `' 23 SOUTH STREET OSTERVILL g. S1 A k,- 7ME• Vk-XlSE 71 L T Y SAND �1,4 rrR JAL Th/AT 1.5 To QE `� �;A` `' �` ; .w .# SCALE: ll EY: PRAWN iY -PLAN RE J 7DVEt� J�AS A PEF2aC' R�T OF- -�l"r.P.!. 1 T LS //CJT Cc?�S/S 1 Dy� r� c�v►� ��: Rf"Sw -11 .3- zs- 9s /MfE�V1UU5 BY TtTLE 3Z 7HEI�'EFt7h'E A /OFT: <0Ve-, Z)/4 !S "�"� :'t27 f'' > > ' �` 4/y IDWARD H. KINGMAN P.E. SCALE : I" : 20' _ Nor R�Cu114k o. F'LElisr 1?EFrR TO : �cz7v<-rsc)GT•Fc/I/ w FfLL S . ' � �r� o, c,x�ATt� EGlSTERED PR7FEssKNAL ENGtEER EC. 1S a Z 7) A D ` PERCaI A Ticl TES ' UAtAM STREET,REHMTK MASS. 0 2769 1 . •D DRAWING NUM11ER ' ITEM Nv.�S�}.UMPFR 7�1$L E D F t EAC'1•ll�C� AREA RE•t.�c,'f!?E,ME/V TS. �' �� - `