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0008 TEA LANE - Health
8 TEA LANE OSTERVILLE 142-157 No. 4210 1/3 BGR ESSELTE _wr. 10% + " 0 0 COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m c DEPARTMENT OF ENVIRONMENTAL PROTECTION i o" 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 142—PARC 157 Property Address: 8 TEA LANE OSTERVILLE,MA 02655 m; Owner's Name: JONES.GEORGE&JUNE r. Owner's Address: PO BOX 507 1 OSTERVILLE,MA 02655 cy} Date of Inspection JUNE 2,2006 Name of hispector:(please print) JAMES D.SEARS 't Company Name: A&B Canco = Mailing Address: 350 Main Street a West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infonnation reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: J Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 6-8-06 The system inspector shall submit 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 tot he buyer,if applicable,and the approving authority. Notes and Continents ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1.5/2000 1 f - Page 2 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&NNE Date of Inspection: JUNE 2,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:.1 _ I have not found any information which indicates that any of the failure criteria described in 310 CNM 15.303 or in 310 CNM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A " 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 complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced ` obstruction is removed ' distribution box is leveled or replaced ` ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). 'The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed . r ND explain: Title 5 Inspection Form 6/15/2000 2 r Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: JUNE 2, 2006 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety;or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 8 TEA LANE OSTERVILLE.MA 02655 Owner: JONES GEORGE&JUKE Date of Inspection: JUNE 2, 2006 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes" or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool �— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in leaching is less than 6"below invert or available volume is less than%day flow 17— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is'within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 s Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: RUNE 2, 2006 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period.? if Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,including 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)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: JUNE 2, 2006 FLOW CONDITIONS RESIDENTIAL,/ Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): YES Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2004—153,000 GAL/2005—197,000 GAL Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 2001—PERMIT#2001-186 Were sewage odors detected when arriving at the site(yes or no): NO Tide 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: JUNE 2,2006 BUILDING SEWER(locate on site plan): Depth below grade: 181, Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): Depth below grade: 21" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance`(yes or no): (attach a copy of certificate) Dimensions: 1500-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to the bottom of outlet tee or baffle: 26" Scum thickness: 1 , Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,TANK&COVERS AT 2 1"BELOW GRADE,INLET TEE—OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ; SYSTEM INFORMATION(continued) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: JUNE 2,2006 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene, other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping' Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS 16"X 16"—32"BELOW GRADE,BOX IS CLEAN&SOLID. ONE LINE IN—TWO LINES OUT. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. t I�i PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc*): h Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION(continued) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&JUNE Date of Inspection: JUNE 2, 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ll'X40'X2' leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS INFILTRATORS, 11'X40'X2'. LEACHING AT 32"BELOW GRADE—WET. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. i CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXlocate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of'cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (locate on site plan) Materials of Constriction: Dimensions: . Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Tide 5 Inspection Form 6/15/2000 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 TEA LANE OSTERVILLE, MA. 02655 Owner: JONES GEORGE&RUNE Date of Inspection: JUKE 2, 2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ZAP v Title 5 Inspection Form 6/15/2000 10 s Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 TEA LANE OSTERVILLE,MA 02655 Owner: JONES GEORGE&NNE Date of Inspection: DUNE 2, 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 9 feet Please indicate(check;:all methods used to determine the high ground water elevation: Obtained from system design plans on record-lf checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators;installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: TEST HOLE AT 9' NO WATER. TEST HOLE 4' BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT 5'BELOW GRADE. _r g Title 5 Inspection Form 6/14/'000 11 TOWN OF BARNSTABLE LOCATION .T L.,. SEWAGE # VILLAGE v ASSESSOR'S MAP & LOT P-12-l5 INSTALLER'S'NAME&PHONE NO. J C. A a l fo SEPTIC TANK CAPACITY I5 0 0 LEACHING FACILITY: (type) Tel .�f��f�b'� (size) NO.OF BEDROOMS UIL D OR OWNER, PERMITDATE: 3- 2 7— 4 1 COMPLIANCE. DATE: ` 3 I Separation Distance Between the: j.: . 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 r i f; t � A 1 2 3 -7 1--- 13 Lo✓P�} a 3 S�. '` l ayi �• 4. ,per -\ COMMONWEALTH OF MASSACHUSETTS EXECUTNE'OFFICE OF-ENVIRONMENTAL AFFAIRS., ' ` T':DEPARTMENT OF'ENVIRONMENTAL-PROTECTION R RECEIVED .uq . ' C'::'V 47 2004 .:`. TOWN OF /�i i TABLE M TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM,r NOT,FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM n PART A CERTIFICATION 2 • wt`-j:r7 ,i.,,.,a !CC .;3 '� re�� �aF,, 7 A?'o-r t k +.s + ��P(z l�' Property Address: v yeci� ay-1�..; , . ..�N�,• , '^, .. .., � 1' .,�-•�;:•.? /o /N c 76 rs �'ARCE� 157 Owner's Name: 4or -4rd tti.n ch LOB Owner's Address:_., .1-Tt� . ' Date of Inspection: 4 1.2 —oy -Name of Inspector: (please print) J404 !!. AaA. Company.Name;. aoA'., Aa If,, gr.ck/+o� .Scr•��� , Mailing Address , �2 �, �.. Telephone Number So q2 F- 99 9 I*s 'Lt, 7 i'• ;y r xea5 ,s 5,st1.eg. CERTIFICATION,*STATEMENT '" I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is.trae,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 P ` :approved system inspector.pursuant to Sechon,l5 340,oLtitle,S DO CMR 15.000).',The.system ' `?"' � �,s 14k•�74,<;r�sy;;�'r� .0 y.� �' ° :^ Passes' rc, Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails - ".�y...�4+, ._�-�2.s ,.as -,d•f«},<..t,•r.,` }'< '��'a K''df "1< � ,i.< 'z; t' :�_..W; Inspector..'s Signature. .+ i a 4,.,Date: . The system inspector shall submit 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, . it '•: x b.',�.: ,r ":t" c.:. k ff ***.*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. "Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAV INSPECTION-FORMr40rA'OR'V0I UNTARY:ASSESSMEN'FS -SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM .. ,.-.,1.4 PART"A CERTIFICATION(continued] Property Address: t IT La 1 a 014- r Os� ��' , r . s rs • Owner: GGvar nn eti Date of Inspection: V—/1-Dy . Inspection Summary; 'Check:A,B,C,D or E/•ALWAYS complete`all"f Sealom.D A. System Passes: V I have not found any information which indicates.that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: �F 1 B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. . Answer yes,no or not determined(Y,N,ND)in the for the following statements:If"not determined"please explain. h._, i+..'7• r "r f:y r l f2 + ,s� M W_. .� ti.Sr..,, t . i s,5,7r< .. ,`Y`The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration'or exfiltration or tank fiflum Is imminent System will pass inspection if the existing tank is replaced witli a'cornplying septic tank`as approved by the Board of Health. •A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating that the,'tank is less than 20 years old is available. ND'explain: . { Observation of sewage backup or breakout.or high static water level in the distribution box due to broken or obstructed pipe(s).or due,to«a broken,°settled or uneven.$istributionbcx.System will pass inspection if(with approval of Board of Health). broken pi*i) _, ,_obstruction is removed distribution box is leveled or replaced t ! I �.:, 't';.�s� :.. i.;�1r Lam. tom.*t' :.Tt �. '".•'J 1 -. 'i 'X ,... ... i:. .. - .. .. . ,. ND explain: The system required pumping more than'4 times a year due to broken or obstructed pipe(s),The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed a. .,.�, L�.is 71. : v of ND explain: Page 3 of 11 OFFICIAL;INSPECTION FORM' NOT FOR VOLUNTARY'ASSESSMENTS ( SUBSURFACE-, SYSTEM INSPECTION FORM x PARTill,. ; CERTIFICATION;(continued) .. Property Address: .9 rFa Owner: c�w " We Date of Inspection: I/—/?-4161 V C. Further Evaluation is Required by the Board of Health: .. . Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. .1. System will pass unless'Board'of Health determines in accordance with 310 CMR 15.303(1)(b)that the... 1°,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'waterw w k Cesspool or privy is withins 50 feet of a bordering vegetated wetland or a salt marsh .r }•��;. _ `y.fi, ."`" ....J'i`C;4{t.a,.....' e,, t k0 :r 1..�jv E t 3 5'�w,.4�i'p n �t ) f i'e.t.a ,.i.'�� a�' ..;4... t .. ♦. i �' - 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the , systemis functioning in a manner that protects the public health,safety and environment: t ;w;:°The system has a septic tank and soil absorption�system(SAS)and the SAS is within.100 feet of a surface water supply or tributary to a surface,water.supply. > „ s :. °.•<zJ: ' #` _ - f 1� ;The system has a septic tank and SAS and the SAS-is within a Zone I of a public water supply: 3'!i r ;j,d',The system has a septic tank and SAS and the SAS is,within 50 feet of a private water supply well. -The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a,' '. !iprivate 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: qyq'-� :S S, s>" ! ":a 1r K:.•. .,ir a t: °. b ,.x :t :>.: . v _., . .r .i..".."li:: jr' .. y':7. ,..•l ..p' ♦-1 t,}..y . #,. .ixb r�sa=.4'�'"� � 1'i .{. ee...�:�, .�. +.it .,'r ,..�:. .€ �:k, L, Y y.•:'!... °. .. - . � ..bt't atl'a. ,x7�.,�:°x ttl ,..iF4 . ., ., r.''�l'. .. tf.. �.�(J".b.. .. 6'?•'� .. � 3 Page 4 of 11 - OFFICIAL INSPECTION FORM-NOTFOR VOLUNTARY ASSESSMENTS : SUBSURFACE SEWAGE DISPOSAIrSYSTEM:INSPFCTIONXOIW_14 PART.AN CERTIFICATION.°(continued) :4 ' Property Address: 8 TQa f.a�d Pit rvi r � o�6sS Owner: Arol urn r h r.?vr Date of Inspection: - i D. System Failure Criteria applicable to all systems:. You must indicate or."no"to each of the following for.all inspections` .: Yes No _ l Backup of sewage into facility or system component due.to overloaded.or clogged SAS or cesspool !.,,Discharge or ponding of effluent to,the surface.of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ v/ 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 Ma day flow h/' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _L::,1 Any portion of the SAS,cesspool or privy is below high ground water elevation. e!.Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.. . . _� Any portion of a cesspool or privy is within a Zone.1 of a public well.. .. Any portion of a cesspool or privy is within 50 feet of a•private water supply well. Any portion of a cesspool or privy is less than.,100 feet but greater than`'50•feet1romz?rivate water supply well with no acceptable water quality analysis. [This system passes if thew avater 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.]:: N0 (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 co=ct the failure. E. Large Systems::,.:.--,., . To be considered a large system the.system must serve a facility with a design flow of.10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of thefollowing: . (The following criteria apply to large systems in addition to the criteria above) yes no f the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes". to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large.system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 •: * OFFICIA:L�INSPECTION FORM `NOT FOR'VOLUNTARY`ASSESSMENTS SUBSURFACE`SEWACE DISPOSAL;SYSTEM INSPECTION FORM PART-B HECKLIST - Property Address: Owner.. `�i�a 24 tiJ. Date of Inspection• y—/2— O`/ Check if the following have been done.You must indicate"yes or"no"gas to each of the following: Yes No ti Pumping informationvas provided by the"owner;occupant,or Board of Health"' ✓Were any of the system components pumped out in the previous two weeks? .... � �c•.:..w rr x,cy++.i... .4�+ .�.•r''� R�. Has the system received normal flows in the previous two.week period? — ✓- Have large volumes of water been introduced to the system recently or as part of this.inspection? _✓.— Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected ected for signs sewage back u P *" Wa • the site inspected for signs of break out? 1 ✓< Were all system components,excluding'the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions;depth:of liquid,depth of sludge and depth of scum? ' Was the facility owner(and occupants if different from owner)provided with information on the proper A:maintenance of subsurface sewage disposal systems? i 4 w The size and location of the Soil Absorption System jSAS)on the site has been determined based on:, Yes no Existing information.For example,a plan at the B'oardof Health. 3 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)] r xs - ,..,., KZ•1 �dj 'Ju'.;Jl5rli6 f_�• 1 �'.kA t � �,c -1 x 1,:x 1 ,.t 1 \ , ._ ,.:.. s,-• ., .-. .. ...... °'ire y 1 , .n4.;{i.Kr ,'._ 4 ,. i r. a I Page 6 of 1 I ;.,OFFICIAL INSPECTION.FORM,-NOT FOR . ,OLU _AAY.ASSESSMEh'3'S . SUBSURFACE SEWAGE-DISPOSAL-"SYSTEM-INSPECTION FORM. ;'PART.0 { SYSTEM INFORMATION Property Address_: .0- MR vlGss' Y' t• Owner: t•, Date of Inspection: /1-d'f FLOW CONDITIONS RESIDENTIAL ' Number of bedrooms(design): Lf Number of bedrooms(actual): y .11 "'DESIGN-flow based on 310 CMR'15.203(for example '110,gpd x Jtof bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage systemL(yes or no);,�v [if yes separate inspection required] Laundry system inspected(yes or no):`_ Seasonal use:(yes or no): No , Water meter readings,if available(Iast 2 years usage(gpd)):�(e t ace-,;,are Sump pump(yes or no) Last date"of occupancy: COMMERCIAL/INDUSTRIAL ' Type of establishment: Design.flow(Based on 310 CMR 15.203): d Basis of design flow(seats/persons/sgf,etc.):- Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no) Water meter readings,if available: Last.date of occupancy/use: OTHER(describe) GENERAL INFORMATION Pumping Records' Source of information:. A',w•+ 1?1,- A, -oi ,1.:y"l140 Was'system pumped as part of the inspection(yes dr no): N� If yes,volume pumped:_gallons--How.was quantity pumped determined? Reason�for.,p, 94 { . . TYPE OF SYSTEM ZSepdc tank,distribution box,soil absorption system _Single cesspool .,Overflow cesspool vy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attanh•a cppy of the currc=operation and maintenance contract(to be obtained from system owner) —Tight tank Attach a copy of the DEP approval Other(describe): Approximate age 0 all components,date installed(if known)and source of information: 1�sfsll�O H' 3'OI i Were sewage odors detected when arriving at the site(yes or no):Ale 6 Page 7 of 1 l" OFFICL 1 INSPECTION.FORM`—,NOT-FOR VOLUNTARY ASSESSMENTS °SUBSURFACE.SEWAGE'DISPOSAL°SYSTEM INSPECTION]FORM 1 , J *�, ✓ P� '. ' "a 1,i Zz "€ y,4S r e. �..r �, ty q.�f _ Jr T C,,1 z tSYSTEM INFORMATION(continued) %+.§ .. Property Address: Os cr�!llo. e�6ss- , Owner: -t7 yen M., Date of Inspection y-/I-o y , BUILDING SEWER(locate on site plan) Depth below grade.-_ ,o' . Materials of construction:_cast iron 40 P.VC_other(explain): Distance from.private water supply,well or. ion line: s Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below-grade: /g Material of construction:. oncrete metal fiberglass olyethylene other(explain) _> If tank is metal list aged_ Is age confirmed by a Certificate of Compliance(yes,or no) (attach a copy of . certificate) Dimensions: Sludge depth: , g Distance from top of sludge to bottom of outlet tee or baffle: 33 Scum thickness: 2 F M Distance from top of scum to top of outlet tee or,baffle ;:. 7 , Distance from bottom of scum to bottom of outlet tee or baffle . x ..How were dimensions determined:: Mea Comments(on pumping recommendatio— ns,inlet and outlet tee or baffle condition,structural integrity,liquid levels T111V as related to outlet invert,evidence of.leak a e;etc): � / D f�',.f {t �n a fi Tunt kr.c f 10 s4/1 rtalr1 GREASE TRAP:_(locate on site plan) 4 'r Depth below grade: 'Material of construction:! concrete TM metal fiberglass_polyethylene other (explain): Dimensions Scum thickness. Distance from top of scum to top of outlet tee or baffle: d Distance from bottom of scum to bottom of outlet tee or baffle. Date of last pumping: N Comments(on pumping recommendations,inlet and.outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.); 01 g ��- r 4Sq� Ud S s i y Y, Page 8 of 11 ('.OFFICIAL"INSPECTION.FORM.=NOTy..?QR Y :UNTAAY.ASSESSMENTS SUBSURFACE SEWAGE DISPgSAL:SYPTEMINSPECTTON FORM: ;SYSTEM INFORMATION(continued) Property Address: ff 7d& A H.c t Owner: ry �ans� Date of Inspection: i/-11-4 V TIGHT or HOLDING TANK: (tank must begun jW at time of inspe=n�an site plan) Depth below grade yt, Material of construction concrete metal fiberglass ._polyethylene other(explain): Dimensions: Capacity: gallons. , Design Flow: gallons/day Alarm present(yes or no): x ' ^ Alarm level: ' '.Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and;float switches,etc.): DISTRIBUTION BOX: 4.-' (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: r 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.): s ... . Aix 'is .tzvt.l .,w/s�rce�`' ,��it��►s C..r�^•te .a-'bwe l �F i=. + , .. .� t i/.✓i.�al:.tr i '•: t 1 - f �.�ir.. t. r ,�.:� r :�rt y-.a g CHAMBER: PUMP`�... R: (locate on site plan) Pumps.in working order(yes or no):' Alarms in working order(yes or no): Comments(note condition of pump chamber,condition ofprmrps and appurtenances,etc.k ^ 41 1 ., . .. ,.t 1:1 f s+ t Page 9 of 11 . OFFICIAL INSPECTION FORM NOT FOR YOLUNTARYASSESSMENTS SUBSURFAC'49i GE;DISPOSAL SYSTEM INSPECTION FORM •' PART,C. , SYSTEM:INFORMATION(continued) Property Address: Ta 1,6„-e, Owner: Date of itnspectlon: SOIL'ABSORPTION SYSTEM(SAS) <./ (locate on site plan,excavation not required) If SAS not located elcplain why.: y� , Type, leaching pits,number:' leaching chambers,number. ' leaching galleries,number:. leaching trenches,number,length: leaching fields,number,dimensions overflow cesspool,number: innovative/altemative system Type/name of technology: P,%75u*e j // X ye".4 Comments(note condition of soil,signs ofhydraulic,failure,levet of ponding,damp soil,condition of vegetation, etc.): f CESSPOOLS:` `(cesspool}must be pumped as part of inspection)(locate on site plan) Number and configuration Depth—top of liquid to,inlet invert: Depth of solids layer., + `� .Depth of scum layer: Dimensions of cesspool: $ �M Materials of construction: " Indication of groundwater inflow(yes or no): - Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on.site plan) t Materials of construction: ' Dimensions:' :.Depth of solids: t ;Y:Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIA olNSPECTION,FORM"6TFOR VOVUNTOY ASSESSMENTS f:SUB_SURFACE'SEWAGF,.:•DISPC SAS`SYS'FENi INSPECTIONFORM a t PART.C.. �... SYSTEM INFORMATION(continued)'. Property Address: 7-0Q La"L ry/Ile, Afffp�6ft Owner:_�o�war j)!=C-1v ' Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM w, Provide a sketch.of ihe'sewage disposal system including des to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public•water supply.enters the building. . ,e 1 . t �g�"7v.Gov[rj r. Q :2 T ` •. Cv✓fir .......,.... _ , ., . . . e,.•cn,ns rt . . _ .. ,�, .. . .. . . y .io of i ,� .:r - ...... .. .... _ "..ra. .,....., G w.al::.Yls„, ..••:;;V 4 t- .,.r. v,:: r .. .. _. , 10• `Faze'llxof ,:, x.. .:.OFFICIAL INSPECTION FORM„ `NOT.FOR VOLUNTARY ASSESSMENTS _ ': ' SUBSURFACE S,IrWAGE DISPOSAL.SYTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued Property Address: 7-2a . n Owner: .v4,jd Din poo ,Date of Inspection: 4/—/2 SITE EXAM ' .Slope ;Surface water }� =Check k'Shallow wells '> Estimated depth to groundwater 46 feet g :Please indicate(check)all methods used to.determine the high ground water elevation: Obtained from system,design plans on,record If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) .� Checked with local Board of Health-explam !.►,ov at Checked with local excavators,'installers-(attach documentation) AccessedUSGSdatabase-explain.. .NAos 'a "13nW. You must describe how you established the high groundwater elevation: N� GbN/Ot�Y Y3 a� J A t I1: •� :0` l pd ' ,t „, , - 5 14 5 F +S f r 11 FY 4 � 4 pf a:, y ! & _ F k y -- .e'u ,! S nf'• L- •; A d ASt���t _ try Property Location: 8 TEA LANE MAP ID: 142/157/// Vision ID:9258 Other ID: Bldg#: 1 'Card 1 of I Print Date: 03/12/2001 �7 -11UIV D A, Element escription F-ontinercial Data Elements Style/ I ype U4 Ca e Cod Element Gd. Ch. Description Model 01 Residential Heat&AC PTO Grade C+ Average Grade Frame Type 14 Stories 1 1 Story Baths/Plumbing ccupancy 00 Ceiling[Wall 24 14 14 Rooms/Prtns Exterior Wall 1 14 Wood Shingle %Common Wall 2 all Height Roof Structure 03 Gable/Hip 14 54 Roof Cover 03 Asph/F GIs/Cmp 22 22 1 Interior Wall 1 08 Typical 2 Element Go de Description Vactor Interior Floor 1 0 Typical Complex GAR 2 Floor Adj BAS Unit Location 24 28 BMT 26 Heating Fuel 03 as Heating Type 09 Typical Number of Units AC Type 01 one Number of Levels %Ownership 12 Bedrooms 3 3 Bedrooms Bathrooms 2 2 Bathrooms 54 20 2 Full Onaaj.Base to u-UU Total Rooms Rooms Size Adj.Factor 1.02241 rade(Q)Index 1.09 ath Type Adj.Base Rate 66.87 Kitchen Style Bldg.Value New 135,011 Year Built 1971 Eff.Year Built (A)1984 Nrml Physcl Dep 16 Funcn]Obslnc con Obslnc 0 Specl.Cond.Code S Code Description Fercen age pecl Cond% ingle am Overall%Cond. 84 —MU s F lu Deprec.Bldg Value 113,400 WAIN WE'D 1!ff q M Go de Description LIV Units Unit Price Yr. Dp Rt %Cnd Apr. Value FFLI lbllrepl ce —Tw— , ",L ,,umm Y,,,A A W AR %5WC A. Go de Description Living Area (irossArea Eff.-Area Unit Cost Undeprec. Value BAS First Floor 01,07 BMT Basement Area 0 1,512 302 13.36 20,195 GAR Attached Garage 0 528 185 23.43 12,371 PTO Patio 0 196 20 6.82 1,337 JIM G7ro—ss LivlLease Area g Vak 135,011 Property Location: 8 TEA LANE MAP ID: 142/157/// Vision ID:9258 Other ID: Bldg#: I Card 1 of 1 Print Date:03/12/2001 Ss P, 0' 'Jor- ��IMT �Mrfi`h -— -------- ..... . mau i . 5M, . A l V LEHMANN,Mr,1A A I K Description Code jAppratsea value ASSeSSea value %DENNEN,EDWARD R&CHARLENE RES-L-AND 1U1U 185'qUU __T95130 801 49 PARKER RD RESIDNTL 1010 115,900 115,900 OSTERVILLE,MA 02655 IVE DATA-Barn.,MA 2337118T- ax Dist. 300 Land Ct# Per.Prop. #SR Life Estate #DL I LOT 2 Notes: VISION #DL 2 GIS ID: ota 'm 9URP-1 ,"t WIJAVPI�M tox 7T�pmp&'fvwp' �yv A- g4,�O rlp,', -_ v DENNEN,LOWAKU R&CHARLENE 133 0/22 q? 1 �146'11ft 00 Yr. Go de Assessed value Yr. Code Assessed Value Yr. Go de Assessed Value VIEHMANN,META A TR 12300/298 05/28/1999 U 1 1F -MR 1(jju 8492UU1999 IUIU 84,_ 84,2UO 2000 1010 101,6001999 1010 101,6001998 1010 101,600 Total. 185,801 —To-ta7:1 185,8001 Total:1 185,80U "M Year lypelvescription Amount Code Descripti n Ivumber Amount Co m.In. t 31,11 T�A "Fl, 11 V 11111 11 '11171"1 Appraised Bldg.Value(Card) 113,400 Appraised XF(B)Value(Bldg) 2,500 Appraised OB(L)Value(Bldg) 0 lfb'ta,Id- Appraised Land Value(Bldg) 185,900 VV Special Land Value R"21" Total Appraised Card Value 301,800 Total Appraised Parcel Value 301,800 Valuation Method: Cost/Market Valuation NetTotal Appraised Parcel Value 301,8uu 'A -"H15 U z" ,UIL B 1w, Permit ID Issue Date Jype Description Amount Insp.Date %Comp. Date Comp. Comments Date ID Cd. PurposelResull WNW A Uq ��WOW�'WVOI -'Ik /1# Use Code Description I-one D lProntage Depth -Units Unit Price 1.Factor SJ U.Factor Nbhd. Adj. otes-Adi/Special racing nt rice and Value 91-ng-Fe Ta—m RC 3 1 0.69 AC 190,000.1JU 1.00 5 -JTAff-_2_.2U SPU _1YTBED G 269,42U.bU 185,9013 Total Card and Un—its 0.09 AU----Idicel I and Area: I;Rtal Land Value 185,9013 L • A TOWN OF BARNSTABLE LCEATION 44 SEWAGE# n VILLAGE ©S ASSESSOR'S MAP&LOT 44Uaa/IVSP�e vR ,,/ S NAME&PHONE NO. 2 0 SEPTIC TANK CAPACITY 5 Z,1`T L //L -C 711 N LEACHING FACILITY.(type) (size) NO.OF BEDROOMS BUILDER OR OWNER 7-0 A,, r -S / PERMIT DATE: C6�EE DATE: a la 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 � ,.;�;� �� , j n�A� , ., � . ��, ��-� ��-y P •� �c,-v �� ', �. 3C' I 9 . . I r TOWN OF BARNSTA$LE LOCATION SEWAGE # 07 0 0 VILLAGE DsI"tv- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. _ L. A., 6fo SEPTIC TANK CAPACITY /5-0 0 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS UILD OR OWNER gee� S PERMTTDATE: 3-2 7— 0 COMPLIANCE DATE: o 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 ?ff�lJ..h -0✓t 1 y f TOWN OF BARNSTABLE LOCATION 8 Tea Lane SEWAGE # VILLAGE- Osterville ASSESSOR'S MAP & LOT INSPECTED BY:NAME&PHONE NO. J.P. Macomber & Son Inc775-3338 B�€ -�A+I+�&=S � SEPTIC TANK CAPACITY, none LEACHING.FACILITY:(type) 3 cesspools (size) 6X8 NO.OF BEDROOMS Bb9liBEROR OWNER Meta Viehmann Realty Trust 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 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fe of �eac *ng facih :) Feet Furnished by 7' C 19 ,q � No.�/a/-��(p Fee THE COMMONWEALVA OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatton for Digogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �Py L�j dS7r�v��� Owner's Name,Address and Tel.No. Pe�Trthe, >3�' Assessor's Map/Parcel 9 7'4 Lh tV rye- Install 's Name Addr s,and Tel.No. Designer's Name,Address and Tel.No. j?�i3mr Type of Building: Dwelling No.of Bedrooms U/ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow `��� gallons per day. Calculated daily flow `rj�" gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �zpe -W. 2 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 . th' Board of Health. Signe Date Application Approved by Date Z 6 Application Disapproved for the following read s Permit No. —?,yy Date Issued Z �� --.__.----------------------------------- No Fee S / THE COMMONVItAL� ,! OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Miopool bpztem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No.} Assesso r's Map/Parcel 9 7t4 L,, ,�Sr�i✓�/�P Installe's Name Address,and Tel No. j Designer's Name,Address and Tel.No. % ,9/3ou 3 y 514 t�72,�Yk Type of Building: Dwelling No.of Bedrooms L! Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures t Design Flow `�`f gallons per day. Calculated daily flow l gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /f✓ate, k 1 ti / lr;" 5 fidS l r � /ZX �0•>X7 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 Board of Health. Signed „� �;%�� r Date —�y- �. _... Application Approved by 1. Date Application Disapproved for the following reaso s Permit No. 2jv / — Date Issued 3 Z Ol THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, th t the p, n-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at T Te G L a.--P, 0 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance ocf�th2s 6rmit shall not be construed as a guarantee that the sy to twill f�xlncir"n as dEsied. Date /�3 0� Inspector f -- — - — — -- -------------------------- ----- No. R� I.?r6 Fee ._7 0. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwigpozal *p! tem Const"Abandon • n Permit Permission is hereby granted to Construct( )Repair( )Upgrade( ( ) System located at Y e- 65 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 mus be completed within three ears of the date of this it. P Y Date: 3/Z �� Approved by Ur 1/6/99 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, ,)o�h /,�c� �f� , hereby certify that the application for disposal works construction permit signed by me dated 3--.,?7—0-/ , concerning the property located at "O g- ZP * (meets all of the a following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) _ r . B) G.W.Elevation +the MAX.High G.W.Adjustment. = 7 DIFFERENCE BETWEEN A and B SIGNED: 4��i1"► C� �4442� DATE: .3 "o?7-"?l [Please S proposed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert ,,--• .- , I IS � � ��fs� ��� � ��' �� �� �/ Nye✓��� � ' � � � \� . %, .� � ,, �. 1 no to .� Tr jT _ 9 r i 2a'-sh° s . 3- O. Q 5•-0u X 5'-5u I 5'-0u x 5'-5u MASTER BEDROOM 9y"LL ® 'r _2"X ,9" 2'1" 9,-5" 2.10" 4'-9u 3-0 BATH a�1 BATH a�j p$ yG� 24D 9� s'�v" ti ° EATING AREA -------- O �� r 4 A J, f-07 m XLU O O GUEST BEDROOM ------- a ul _____ _ N KITCHEN 2-4 - ________ • BATH ��, 3h 19-9° ---- `s J '9 2-1$ e 4 9 4 SITTING ROOM HOME OFFICE 4 2 CAR GARAGE LIVING ROOM O FOY F O 4 2'_2"X 4'-9'n n 20'-W 9 M 4 9 PO RCH m Q :;;)'-P X b•-II' I'-i°X 6'-11"'" Y_Ip"X 4'-9' Y-10" 12.5" m Y-10" 4.9" Fnblic Health 131111s►o tt lc� ����. Town of Bamstabt ril S�— PO Box 534 uses 0260 . FIRST FLOOR P N Hyannis,Maser > Fax(508) g�65 s y Phone pb)7 6w r a J „9,L C ea ith Bivisian Town of Barnstable PO Box 534 chusetts 02601 o Hyannis,Massa � � a Fix(508)77 = o w Phone(508)790-6265 LIL- ,6-,4 X,P,S , ^9-,L ,E-,L ,9•,9 ,f-,L ,9-,L • DATE• 9�6.�0----- PROPERTY ADDRESS:--�`:____,.._____..__..____-- !.L-Tea Lane Qstervi_l_1_e�Maw._Q2655____ On the above date, I Inspected the eeptlo system at the above address. This system' conslsts of the following; 1 . 3-61X8' cesspools Based on m'y Inapectlon, I certify the following oondltlonst 2 . This is not a title five septic system. 3 . This is a sewage system. With three cesspools in series. The main cesspool acts as a septic tank.Waste is held in the main cesspooland the effluent passes to the two overflow cesspools. 4 . Both overflows are dry 19" of -waste water in .the main cesspool. 5j The sewage system is in proper working order ` at the _present. time. SIGNATURE:,, Name :_,i,_P �APssmta.r- ------ Company:J0e•Ph_?_ Hecomber_b Son , Inc . Address ;_ Box-66_____________ Centervi11eL Ha_ 02632•-0066 Phone:___ S08_77S_ THIS CERTIFICATION ooES NOT CONSTITUTE A QUARANTY OR WARRANTY C P. MACOMBER & SON, INC. +►nC1sspools•L,ichf"Id,Pumpod 4 Inr<tilledTown Sower Connootlons 6y75•JJJ8s�Illf, MA 775.6 1Z2632.0066 j E P 2 COMMONWEALTH OF MASSSACHUSEM. EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY CORE Secntuy DAVM B. STRUHS ARGEO PAUL CELLUCCI Commissioner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECT'10N FORM PART A CERTIFICATION Propwty Addrs';8 Tea Lane Name of Owrw Meta Viehmann Realty Trust Osterville Address of ownw: 35 Lucerne Drive Douo}�6W'—__ nn �Joseph P. Macomber Jr, Andover, Ma. 01810 Name of Inspector:lr'►a+s�►rthtl I wn a DEP approv+d systam 4up ctoe pursuant to Section 16.340 of This 6(310 CMR 15.000) C,r.pa,ry Nafi1e: Joseph P. Macomber & Son Inc. Maiusg A6drnss: o x e n e r v 1 e M 6 3 2-0 0 6 6 Tokophcne Nurnbw' — — i CER CAMN STATEMEM I certify that I have personally Inspected the towage disposal system at this address and that the Informedon reported below Is true, accurst• and complete as of the time of Inspection. The Inspectlon was performed based on my training and experience In the proper function and ma,ntenancs of on-site sewage disposal systems. The system: I— asses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority ?rshall ils enDena: spsctor s SignstThe System inspe submit a copy of this Inspectlon report to the Approving Authority(Board of Health or DEP)whhln thirty (30) days of completing Ws 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 otflce of the [)apartment of•Envlronmerasd Protection. The original should'be sent to VW system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page I or it " MAW on Recycled Psper L SUILSURFACX SEWAGE DL3POSAL SYSTEM INSPECTION FORM C PART A > (:£"1ACA'n0N (oon*"od) Ptopw y Ad**": 8 Tea Lane, Osterville j Owrbw Meta Viehmann Realty Trust DSca of hape.cdon: 9/6/0 0 "SP£CT10N SULAMARY: Ch ck A. .B, C, or D. A: . YSTn.+ rAssrs ,elj I have not found any information which Ind)cates that any of the f4ure con tdoru described In 310 CMR 14.303 exist Any taw crft#rts not ovaJustod are Indicated below. CO W.L.ENTS: S. SYSTDA CONDIT10NA11Y PASSES: ` ��• One a more system components u dosor(bod In the 'Conditional Pans' section need to be replaced w repaired. The oyrt*m. upc comoodon of the ropl000ment or repair,as approved by the$Gard of HsaJth, will paaa. U-4cate yes. , or not d.termined(Y. N, w NO). Do*aW@ baala of detwminadon In all It"tuwes. If 'not dotermined', sxoWn why not. QLF� The sepdc tank la mota.), unless the owner or operator has providod the system kupWor whh a copy of a C4M'Acat• of CompUance (attached)Indicating that the tank was metalled within twenty(20)yows prior to the data of the Inspycvon; the sopdc tank, whether or not metal,Is cracked,svuawraUy unsound, show#substandal InNvadon of exfirvedon. a u ,allu(e Is Imminent. The system will pass Inspection If the oxistinp septic tank Is replaced whh a con%Oytnp sepdc lane r approved by the $card of Hsahh. do water level observed In the distribution box la duo to broken or obovvcced pip-4 Sewage backup or breakout or high its or duo to a broken, settled or uneven dJeVlbutJon box. The system will pass tnepsation If(whh approval of tha Board of Health). broken pipe(&) are replaced obowcdon Is removed distribution box is levelled or replaced • The syrtom rsquired pumphigvywre dun'fourtlmoo s"ardue to broYenw obstructed plpe(s). the vyavrm w*-pw — Insipection It (with approval of the Board of Health): " broken plpe(s) wo replaced obstruction is removed revised 9/2/98 Page 2ofIt I f SUBSURFACE SEWAGE OISPOSAL SYSTEM INSPECTION FORM+ �. PART A CERTIFICATI ON oorrdnugod) Propomy Adclrwt 8 Tea Lane, Osterville OwrAt: Meta Viehmann Realty Trust D.0 04 `"`p"`s«" 9/6/0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health In order to detarrnln•If tha system Is NAIng to protect ttw public health, ssfsty and the environment. 11 SYSTUA WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310=A 16.303(1)(b)THAT THE SYSTEM IS NOT FVNC'T10NWG IN A MANNER WH)CH.WILL.PA03ECT THE PUSUC UEALTRAND L FETY AXD THE 9C4S0kJrLE9rL Cesspool or privy Is within 60 feet of surface water Cesspool or privy Is within 60 teat of a bordering vegetated wetland or a salt marsh. r 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBUC WATER SUPPLIER, fF ANY)DenD AD93 THAT THE SYS7E3+ c4 FUNCTIONING IN A I.tANNEA THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ElifVIRWUdENT: The system has a septic tank and toll absorption system (SAS) and the SAS Is wlthln 100 feet of a wriace water wP;wy or uibvisry to a suriece water supply. The system has a septic tank and toll absorption system and the SAS Is within a Zone 1 of a pubUc water supply well. The system Ms a septic tank and *all absorption system and the SAS la within 60 feet of a private water wpN ts Y we . The system has a septic tank and loll absorpvolatiletion system and the SAS Is Iota then 100 teat but 60 feet or more hom s r analysis for collform bacteria and volatile le organic compound+ Inu dJte+ private water supply well, units$ a well wall trot tree wall Is free hom pollution from that facility and the presence of ammonla not valid).- andnitrate nhfogen is 9Qu4J to or less than 6 ppm. Method used to determine distance�f ,__ lappro JI OTHER This is a sewa e s st qeso oo ain cess ooa-,-A-'sie-pJ7Jr— ti e wo over cz hAnr11 afa the main cesspool. Solids are contained in the main cesspool. s Pees J of 11 revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL A SYSTEM INSPECTION FORMA PART �J CERTIFICATION (corsdn0 d) 8 Tea Lane, Osterville Owner: 'Meta Viehmann Realty Trust oete of waP+cd°n: 9/6/0 0 D. SYSTDA FAILS: You must Indicate either 'Yes' or 'No' to each of the following: _ I have determined that one ofmore The the rdfollowing failure confth shouldbedcontacted to deterrlllrnin(whatOwlMbe n case"to t:orract the tailu determination Is Identified below. Yes ovodood+d orvwgg�No_ / 09Tpon�doe�to art BASor-eeeapol. .�..-•- - ` (/ Backup o+Mwage Inwf�clllty�or•+Tet+rt+ +r1°+tied a Clogged SAS or Discharge or ponding of effluent to the surface of the ground or surface waters due to an ov cesspool. Static liquid level In the distribution box above outlet Invert duoto an overloaded or clogged SAS or cesspod. Liquid depth In cesspool Is less than 6' below Invert or available volume Is less than 112 day flow. _v Required pumping more the 4 times In the last Year NOT due to clogged or obstruetld PIDi(s) '— Number of times pumped�• , cesspool or privy Is below the high groundwater elevation. Any, portion of the Soil Absorption System surface water supply or tributary to a surface water wpPIY• Any Portion of a cesspool or privy is within 100 feet of a Any portion of a cesspool or privy le•wlthln.a Zone I of a public wall. Any portion of a cesspool or privy Is within 50 feet of a.private water supply well. Anytabi n then 100 feet but greater than 60 fast from a private water supply w*U with p of s cesspool or privy Is less eptable, attach copy of wall water +nelysls o acceptable water quality analysis. 11 the well has been analyzed to be acc -colltorm bacterla,'volatlle organio•compounds, ammonle nitrogen•ond nitrate rJtrogen. �. LARGE SYSTEM FAILS: 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: 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 health and safety and the environment because one or more of the following conditions exist: Yes No the system Is within 400 feet of a surface drinking water supply /the system I►•within 200 fret ZoM II of • D the !� system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a rnaPDed water supply well) ordant•with 510 CMR 16.304(2). please consult the 1oGat The Owner or operator of any such system shall upgrade the system In acc rat office of the Dspartment for further Infognabon. Pa(lsorit revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL 3YST04 INSPECTION FORM PART 111 1-711 CHECKLIST PropwtyAddrow 8 Tea Lane, Osterville Own«: Meta Viehmann Realty Trust Dou of 4>apectlon: 9/6/0 0 • f Check If the following have been done, You must Indicate either 'Yes' or 'No' as to each of the following: Yes No , Pumping Information was provided by the owner, occupant, or Board of Health. Norw of the systemeomgw&&nU hawbaan pawyad4oP4*Jaastiwo•waaJw as&tJ;wlystam hasbaaowcoltassgmwmw r rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of uvs Inspection. As built plans have been obtained and exemined. Note If they are not available with /A. The facility or dwelling was Inspected for signs of sewage back-up. !� The system does not receive non•sanJtary or Industrial waste flow. _ The she was Inspected for signs of breakout. All system components,�ZIuding the Soil Absorption System, have been located on the site. _AIOVt_ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of bet or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: Existing Information. For example, Plan at B.O.H. v Oetermined In the field(II any of the failure criteria related to Part C Is at Issue,approximation of distance Is unacceptao 116.302(3)Ib1l The facility owttar (and.or_;s ■,Jf dltlaraat lroatauroar),wraia.�rauldad,wlth latncraasloaon ►hami,•,m•:n+•�•ti SubSurfece Disposal Systems• f r - j revised 9/2/98 Pagisorii I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Proq•wty Ad&o": 8 Tea Lane, Osterville Owner: Meta Viehmann Realty Trust Da,of Ir»p.ction: 9/6/0 0 FLOW CONDITIONS RESIDENTIAL: D@slgn flow: 60 _g.p•d./bedr Number of bedroom 1 Iq 1: Number of bedrooms (actual):Total DESIGN flow r' Number of current residents: f � Garbage grinder(Yes or no); _ Laundry(separate system) or AV if ut 1 If yes, sspaaJnspacdoo.raqulrad Laundry system Inspected no) Seasonal use (Yes or no): Water meter readings,If a able (last two yesr's usage(gpo). Sump Pump(yes or no):N�/ lei Last date of occupsncy:z=e r,OMM E RC1AL/W DUSTRIAjj Type of establishment: Design flow: d ( B sad on 16.2031 Basis of design flow Grease trap present: (yes or no) Industrial West@ Molding Tank present: (yes or no)� Non•sanitary waste discharged to the TI s 6 system:(yes or no _ Water meter readings,If available: Last data of occupancy: OTHER:(Describe) 'U f Last dote of occupancy: GENERAL INFORMATION PUMPING REFO S s urc I Informatlo w�% , SIC !" `� �V Syst@m pumped as part of Inspection: (Yes or n dfdffl II yes, volume pumped: 0 gallons Reason for pumping: /rill ------ TYM OF SYSTEM 0 Septic tank/distribution box/soil absorption system _T Single cesspool ao _ Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous Inspection records,If any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other 00 l APPROXIMATE AGE of all components, date Installedilf known)-and sours+o(JwioM%atlOn: G Sewage odors detected when-arriving at th.0 silo: (yes or no)I&A P.eeticrll revised 9/2/98 C SUBSURFACE SEWAGE DISPOSAL 'SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(C*n*%-Wd) pr.opwTy Addrasa: 8 Tea Lane, Osterville Dwrw: Meta .Viehmann Realty Trust Data of Inspection: 9/6/0 0• BUILDING SEINER: Il.ocat•on site plan) Depth below grade: � Material of constructl v c/a+t Ir A)D 40 PVCother (explain) YVI Distance horn krt•vs water supply well or auction line Di metal�Y_ mrpsn a: (condition of Joints, venting, •videnca of h►aka�e,ric.)> Joints appear ti h . T even SEPIM TANK" flouts on she plan) Depth below grade'�IQ Material of constructlonAgconcr•t@4J •ts14./&#Fibergias$4, Polythylenvllother(explaln) 4-11-4 If tank Is tnetal. list age is.age.confVmed by CertIflcato of Compliant• (YesfNo) Dimensions: Fb4 Sludge depth: Distance from top of sl dge to bottom'of outlet tee orbroffie:/y`�' Scum thickness: Distance trom top of scum to top of outlet tee or baffle: A1.4 Distance from bottom of $cum to bottom of out(• tee or bat•f1e:�� Mow dimensions wore determined: �� Comments: (recommendation for pumpin condition of Inlet and outlet tee$ or-baffles, depth of liquid level in relation to outlet Invert. $tructvrar•:nto9rrty. do co of leak+ •, etc.) ,the main c should be niimnpr-1 �arrbage dgisposa ispresent - GREASE i TRAP: (locate on ills plan) Depth below grads-N� Material of constru n40concro s.&motal�FiborglasadJ/�•PolythylonJ oth•r(ezplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet too or baffler Distance from bottom of slum to bottom of outlet tee or baffle Date of last pumping: Comments: fy (recommendation for pumping, condition of Inlet and outlet tea or baffle, depth of Iiquld I•wl In relation to-outlet invert, etrvcturai Intog& evidence of leakage, etc,) Grease tra e7of11 .. revised 9/2/98 Pa i SU93URPA"SEWA0E 013POSAL SYMM W3KC-1 tON FOND J� PART C SY3TuA wr-oF Amw (corrdnuad). Proqorty Adao": 8 Tea Lane, Osterville Meta Viehmann Realty Trust D.o of►n.a.ed«c 9/6/0 0 n0KT ON MOLDING TANK: (Tank must be pumped prior to, or at tJma of, Inapicdon) Notate on site plan) Depth below grado: 4/0 Material or conswcdon:A/�concretk/A_metalAf�Flberpl►� 4►olyethylenuotherlexa+ln) Oimonslons: AM Capacity: gallons Oosign Itow: g►llons/dsy Alarm pfeFent Alarm iawl; Alarm in x+o(klnp order:Yea/ Not Oslo el prevlovs pumping: Comments: Iconddon of Inlet its. condJtJon of alarm and float switches, *to.) ins an arp r-Lni—�efae wTRIsvnoN sm-AI'VL vocals on site plan) Depth of ligvld level ►boy• ovtlst Invert:�� Comments: Inose If level and dletribvtlon Is equal, evldsnoe of solids carryover, evldonoo of leakage Into of ovt of "ll, O%C-I- u1strijbDu PUbtP CF{AI.IBEA:�iUe. 110481e on site plsnl Pumps In working order.IYes or Nol Alsrms In working ordef IYss of NO Comments: Ingle condlG'on of pump chamber, condltJon of pumps and appurtenances, etc.) er 1 not , Pala I of 11 2/98 ed '9 e vis / r . r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (eontirwod) PmpertyAddress: 8 Tea Lane, Osterville owner: Meta Viehmann Realty Trust Data of Inspection: 9/�,�6n/0,0I�J,,,. SOIL ABSORPTION SYSTEM(SAS):A�!►� �"'^�^^k/ &Vyeld� (locate.on site plan. If possible, excavation not required,location may be approximated by non-Intruslvo methods) If not located, explain: Type: D leaching pits, number: leaching chambers, number: leeching galleries, number: leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, numb r,1.9 Alternative system: i Name of Technology: LO Comments: (note condition of soil, signs of hydraulic failure evel of•ponding, damp soil condition of ve station, etc.) Loa l"10 signs of h craulic failure or pon ins of s are dry VPUPtAti nn ; c nr,rmal CESSPOOLS: rd (locate on site plan) Number and configuration: v A/y Oepth•top of liquid to Inle pert: Depth of Bonds lays: Depth of scum layer. Dimensions of cesspool Materials of construction: Q Indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) No evidence Intiow cesspool wag not p t� tm=A� n—Ath of tho were dry. Comments: (note condition of soil, signs of hydraulic failure, level of pending,condition of.vegetation, etc.) ame as above PRtvY:,�.tJ� Ilocst• on site plan) Materials of constructs 1410 Dimensions: 411� Depth of sollds: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy is not DrP-,Pnt revised 9/2/98 Pset9of11 l_ . bV&3Vlt/ACt S9WAOL 01,3 TALC YeiTVA WiKCnON/ " SySTeA WfOPJJATtON 160ndfu*41 hop«�Y Ad& 8 Tea Lane.,• Osterville 0~: Meta Viehmann Realty Trust 9/6/0 0 SICETCX Of SEWAGE OtSPOSAL SYSTEW IAGJVde dee to eI leoet two porm+nont roloronco I+ndmuko of aonchmOmol is 110U+e1 locete ►II wells wlWn 100' ILoc+to whore publlo w+tet' +upplY O 0 O n l 14 Al . hie 10 of II revised 9/2/98 3U93URFACE SEWAGE Dl3►QSAL SYSTEM WS/ECTION FORM PART C SYSTEM PFOR1MA noN Icontirwedl propeny Ache,: 8 Tea Lane, Osterville Owner: Meta Viehmann Realty Trust O.0 of tnap.cdon: 9/6/0 0 NRCS Report name Sou Type_ Typical depth to groundwater VSOS Date wobslto vlsltod Observation Wells checked Oroundwoter depth: Shallow Moderate .Deep SITE EXAM Slope Surface water Check Collar Shallow wells Estimated Depth to Oroundwaurst mosso Indicate all the methods wood to detormino Hlgh Groundwater Elevation: _Obtained from Design plane on record Ob orvod Site (Abutting pro art boorvotion hole. baoomoot wmp eta.) Determined from local condl0ono Chocked with local Board of health Chocked FEMA Maps hocked pumping records hocked local excavators, Installers Vied VSOS Eau Do scribe how you established the High Groundwater Elevation. Qjw be completed) Used; Water contours map. Gahrety & Miller Model 12/16/94 revised 9/2/98 hceltorIt l 1 r..-�. ..�......-��� BARN TAB.E _ WARD OF HEALTll � 'I'UNN OP 9U11,9Uf1FACF 9EKAOF I)19f'U.9AL SYSTEM INSPECTION FORM -' PART D •- CERTIFICATION -�.,i.-.�r.�w,r+ww►,�.r wq..•wTtr,�.w�.+ti�-�+w�.w�wr+��� -^ -TT►C OA FEINT CLCAALY- PROPERTY INSPECTED STREET ADDRCSS 8 Tea Lane Ostervill ASSESSORS NAP , BLOCK AND PARCEL 0 OWNER' S NAME Meta. Viehm PART D - CERTIFICATION NAME OF INSPECTOR Joseph P. Macomber Jr, COMPANY NAME Jose h P . Macomber `Son Inc a Centerville M.A. 02632-0066 COMPANY ADDRESS city Town or ><t�t• t tr••t - _ FAX ( 1 COHPANY TELEPHONE ( 508 ) 775 3338 CERTIFICATION STATEMENT I certify that I have personally i.nspeeted the sewage diaposa`1 system at >recoinmendaL' his address and that the Information reported inspeetion true was accurate performednand any omplete as of the time of � InspectionI The lolls regarding uNgrade , maintenance , and repair are consistent With my training and experience in the proper function and maintenance of on- site sewage disposal systems Check one !e Systeui PASSED " nducted has not found any information The inspection which I have co which indicates that the system fails to adequately protect public or the defined In 310 CHR 303 . Any f criteria not evaluated are nsstated in theFAILURECRITERIAsection of this forin . System FAILED* The inspection which I h11andve o votedcn theenv found tem ironmenti ' that n accordance s fails to with Title protect the E)ublic lie 5 , 310 CHR 15 . 3031 and as specifically noted on PART C - FAILURE CRITERIA of this Inspection orm , ' Date ^� Inspector Signatur 0n copy of this ertificatio.n must be p ' vided to the OWNER, the BUYER .8h. rq •vD11o•bl• ) •nd the DOARD OY KEALTII , if the inspection FAILED , thb owner or"operator shall upgrade ' tho system Nithin one year or tl)eidat �Oof the 16is ection , unles>a allowed or required otherwi3e as provided partd , doc L