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Home My WebLink About0033 BLUENOSE LANE - Health 33 Bluenose Lane Marstons Mills A= 121 — 144 - 006 J 73 TOWN OF BARNSTABLE LOCATION (.>d `'�`"/ ��c �,8�e L o,�J SEWAGE # VILLAGE—() ASSESSOR'S MAP & LOT 12 L 01"ph '\IIVST.ALLER'S NAME & PHONE NO. T 1'. ��c:T461' 77 (- e 17 r j SEPTIC TANK CAPACITY , (��`� q it I`Gy�j LEACHING FACILITY:(type) L-pA (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER; BUILDER OR OWNER DATE PERMIT ISSUED: �� 1 DATE COMPLIANCE ISSUED: VARIANCE GRANTED. Yes No ��\ ;�. / d �.�.._ ,. — — �C:�tv=ter � 4 �. �` � �C v , FEs.__....��..� 7...... y THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH D cinf--------------OF.-.-..T-.fArt�/s'tP/r c Appliratiun for Dhipasal Works Tomtrnrtiun Vrrmit Application is hereby made for a Permit to Construct 04 or Repair ( ) an Individual Sewage Disposal System at ....Lai Y`( TIL uc�,vc�E. b •- • -•-•••............-•--•- .. -- cation_.lddress or Lot No. "Ziff Address Installer Address Type of Building Size Lot.a d7_ .......Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic el) Garbage Grinder,) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures _______________________________ __ W Design Flow............... .....................gallons per person per day. Total daily flow...........:3__�•'__6_.__________.________galIons. P4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by-_________��?'�xF _.....��___ _________________... Date....��__/� -------•�� ------- --tt-- Test Pit No. 1_.�a_.____minutes per inch Depth of Test Pit____N __�_ _____________ Depth to ground water..... 1-_________ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------•----------------- �-4-/J1!!r'f ��.g�'".. �o O Description of Soil.......... x •- ---------•................ .....•-------•--•-------•---•-------••-•----•--------------•--•-----••••-•-•---••-•------------••- W VNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ --•-----••--•-•--------•-••••---------•-----•-••-•••••••-•-•••---•••-------------•._......-•--------------------•--•-•--•------••-•-••-•--••------•••----•---•-•--•-•-•••--••--•------------•........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �^ the provisions of :.!-1:.T./�1 L of the State Sanitary Co A. e undersigned further agrees not to place the system in operation until a Certificate of Compliance has n?Led the boar 1 Signed :..... == ------ /�d/ � Date J ...._._ Application Approved By............... �-� _---- " __-________-_-------•------- --------/ __� ` Application Disapproved for the following reasons-............................................................................................................. -----•-•--•-•-•--------------•-------•------------------ ----------•-•••••----•--••••----------•--••-------_...__....••-•-••--•-•••----•----•------••••-----•-•-•--------•----••--••---•--••----_._...._ Date Permit No......... ".:: ---------------- Issued....................................................... Date y , No................--.....-- ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............OF.......°............................, .......................... --------------------------------......-•---.. ApplirFation for Dhipati al Works Tonutrurtiun "unfit Application is hereby made for a Permit to Construct (44 or Repair ( } an Individual Sewage Disposal System at: ................__................................................................ ..--•• --..../...•---•-------- ------_..._ ------------ Lat � io Addre tio. [ _� c-..._ Slo. .......... ----- ... ; ---------------- Owner Address ........ Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic (o'+ ) Garbage Grinder ( ) '4 Other—T e of Building ............... No. of persons........................_... Showers — Cafeteria Q' Other fixtures ................................. W Design Flow...............5.15......................gallons per person per day. Total daily flow............-_.:..it.....................gallons. WSeptic Tank—Liquid'ca.pacity........_.._gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching.area..................sq. ft. Z Other Distribution box ( ) Dosing tank. Percolation Test Results Performed b . '" 3` ......a..__^. " .............. ___ a Y-----------=-- -----•-- Date-------t------• ---=---- ,.a Test Pit No. I__«'-------minutes per inch Depth of Test Pit.....j :-•____•- Depth to ground water_-_ GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-__•-_--__---__-_-___-- a --------•--••--•--•-•-- ------ - --------- O Description of Soil----------�°` '3=` t/ "i --a tr. ..._..�..........._5'"^''�...............•-.....-----------------------------..................... .....--------•---.. x -- V •---•-•--•-••-•-•--•-•-•••----•-••••-••-•••••----•---•-•••-•--•------•--•••--••-•••--•--------------•••-•--••--•-••••••••-•••-•••••••----•-----••-••-•--------•- -------------------------------------------------------------------------------------------------•---------------------------------------------------------------------....-----••----••-•-•--••-••••. V Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------------•--------------------••------•----•---•----------.........._..--------•-----•------......----•----•-•------•-------•----•--•----.............-•••-•------...--••-- Agreement: The undersigned agrees to instal( the aforedescribed Individual Sewage Disposal System in accordance with the provisions of!7:T/-1y t E 5 of the State Sanitarq-e Co — he undersigned further agrees not to place the system in operation until a Certificate of Compliance has n is ued the boar f h r d f 1 `.. & l" Signed.J.--:---. = �` = mate Application Approved B ......_.... , Date Application Disapproved for the following reasons:---•---------------•---------------•---------------...----•---•------------------------------•-•-•---•........_ ....................•-------.........----....._..-•-----------•--•-•-••------------......-•..------------••----•---•-•--•---••-••-•-•------•-•-••--------.............................................. Date Permit No.------.. 51t:47---------------- Issued-•--------•------------------------.__.---__------------ Lat., THE COMMONWEALTH OF MASSACHUSETTS ,J BOARD OF HEALTH t ........................................_OF...... ..:.:'.'..................................................................._... TlertifirFatr of TompliFana THIS IS TO CERTIFY, That.theJndiv'dual Sewage Disposal System constructed O or Repaired ( } by--------- .................................. ------------••-- at.............................................................................................................................65_1............................................................. has been installed in accordance with the provisions of TIT%.E 5 of The State Sanitary Code as described in the application for Disposal Works Constriction Permit No. �.�f ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE FACTORY. _. ..- EIoA WILL o. DATE................ F I r N S Inspector.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ............................ ---.............................. No... .,,... j! FEE.....j .. �iu�ru�atl orku �unu#rnr#ion pranit Permissionis hereby granted ...--..........................••--.--........-•-•-----------............------------.....-----•--..............................--- to Construct (�>') or Re��ggair ( ) an Individual Sewage Dis osal �S•ystem i �— at No.--•••-.< f-•--•••-•-I`l_... .3_� V fi .v O ...............-.. .... ..= ....5l street t as shown on the application for Disposal Works Construction Permit No...; _1 je 7�Dated.......................................... ....................................- . ....d--?----............................................... DATE--------. ...0..... •-----•-• 19............................. oard of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date I®� 3� [O Time: In Out e Owner Tenant , C� Address 66 1 Address 3 3 Complia ce Remarks or Regulation # Yes NO Recommendations 2. Kitchen Facilities _ 3. Bathroom Facilities 4proved: I 4. Water Supply 5. Hot Water Facilities 40-�� 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use - 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and.Rubbish Storage and Disposal 16. Sewage Disposal �- 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed �� [ 60 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS w DEPARTMENT OF ENVIRONMENTAL PR 10AP 12l REC �'AyR.CEI� �_ JUN 3 0 2004 C C��1 0r0 LOT e ' M gv TOWHEALTH DEPT. L TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner's Name: REBELLO Owner's Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Date of Inspection: 6/15/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS . Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Tit e 5(310 CMR 15.000). The system: X Passes _ Conditionall sses _ Needs Furt valuation by the Local Approving Authority Fails Inspector's Signature: Date: 6/15/04 The system inspector shall submit j opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti . If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shaIf 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 SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.D-BOX WAS VIDEO INSPECTED-RECOMMEND LOCATING AND RAISING COVERS TO D-BOX AND LEACH PIT.RECOMMEND NOT DRIVING OVER D-BOX. ****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 S ImnPntinn Fnrm 611 V?00 l 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.D-BOX WAS VIDEO INSPECTED-RECOMMEND LOCATING AND RAISING COVERS TO D-BOX AND LEACH PIT.RECOMMEND NOT DRIVING OVER D-BOX. 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. n/a 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. ND explain: n/a n/a 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: n/a n/a 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 ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland 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: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 n/a "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. J 3. Other: n/a .Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspecti6ns: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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.] 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: 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 the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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. d 'Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 Check if the following have been done.You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ 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? X _ 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 no X _ Existing information. For example,a plan at the Board of Health. X _ 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Numb--r of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): tva- Sump pump(yes or no): NO Vr 1 Last date of occupancy: n/a V COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no):NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a 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: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attacr 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 a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: .1990 PER AGENT Were sewage odors detected when arriving at the site(yes or no): NO F Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO - Date of Inspection: 6/15/04 BUILDING SEWER(locate on site plan) Depth below grade: 22" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting, evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 16" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 1011" Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: MEASURED f Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPINGNOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 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: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a r, Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): (H-10)D-BOX WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND.D-BOX HAS SOME SOLIDS IN IT.RECOMMEND NOT DRIVING OVER. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 'n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): DID NOT EXPOSE LEACH PIT,APPEARS TO BE STRUCTURALLY SOUND.SYSTEM SHOWS NO SIGNS OF FAILURE.LIQUID IN D-BOX WAS LEVEL WITH PIPE-RECOMMEND LOCATING AND RAISING COVER TO PIT CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction:n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 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. A 12 10,41-7 c )b in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 33 BLUENOSE LANE OSTERVILLE,MA 02655 Owner: REBELLO Date of Inspection: 6/15/04 SITE EXAM _Slope. _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting properly/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER WAS DETERMINED FROM HAND AUGER-NO WATER AT 12' 11 s rn 10 > NOTES. , MAkSTONS 'MILLS o 0 1, ALL, WORKMANSHIP.,AND 'MATERIALS SHALL' CONFO MJO ,D.E.O.E. W 20'�M04" ON AS PIWAM VN PLO TITLE 5 ; THE- TOWN OF . BAR STABLE ,- -,,RULES -AND A-Z FOR THE I SUBSURFACE DISPOSAL OF SEWAGE- REGULATIONS 0 Locu ur AND THE REQUIREMENTS OF THIS PLAN. 10,-NMI" - 2. ALL COVERS TO SANITARY -UNITS SHALL-BE :SROUGHT TO RojjTE 28 ROUTE 25 &&am WTH 'WITHIN 12" OF- FINISHED'..'GRADE. BLUENOsLt- TA F"DA710141 LAmE -UNITS USED :BRIN &10.0 3. ALL�,MASONRY G' COVERS% TO GRADE SHALL'BE MORTARED IN PLACE. 4. 'ALL. COMPONENTS OF ,THE�SANIITARY SYSTEM SHALL.BE CAPABLE -IOLOADING UNLESS THEY ARE'UNDER OR OF WITHSTANDING H 1 4' PCR rT. wk. PITCH 1/1, pa PITCH 0 sm. 40 PVC PIK WITHIN-10 FT. OF DRIVES OR :PARKING AR AS., , :20 'AD N r LAm cw �USED 'UNDER OR WITHIN 10 FT.I OF OR 5; r==�u , __ I � I I fLow LNE SHALL,BE DRIVES PARKING, '5. 1467 0 :2' 'A 2" Liam + > EFFLUENT PIPING FROM -BOX'.,SHALL ENTER LEACH PIT DISTRIBUT10N THROUGH SIDEWALL OR'JOP NLY. .ENTIR AN`cE-THROUGH MASONRY LOCATION 'MAP; ''Box - ILL NOT 'BE -AILOWED.EXTENSION �_7. NO DETERMINATION,-HAS� BEEN IMADE ,AS�:TO -COMPLIANCE -WITH DEED dALLON S&MC TAW -REG ILAONS. -OWNER/APPLICA�NT. RESTRICTIONS �OR 'ZONING U OBTAIN ,SUCH DETERMINATION.FROM,T14E RITY. OOMATE.�AUTHO SEWAGE -DISPOSAL SYSTEM PROFILE B0TTbk :OF,'l`EST HOLE 4`7 ?1 8. HORIZONTAL AND VERTICAL Cbl4*R6L4.-'SEE, LEVY,.'ELDREDGE NOT 70 SC" WAGNER FIELD iNOTEBOOK .4 WATER LE�EL OR USOS PROBABLE HIGH -DESIGN: CAL CULATION8' ON CURRENT ZONING JNTERPRETATI MIN.- FRONT-SETBACK ;FEET � NUMbER OF BEDROOMS ARBAGE. S -�DISPSAL UNIT MIN. SIDE E"ACK T OTAL: EST)MATED :FLOW '!_5_0dAL'/DAY T� �,' MIN. A AR SETBACK GAL./8R.' 110 /DAY X : BR�) GAL 'tQUIREt) :SEP!lC,.TANK'-CAPACIV� A "SIZE OF' SEPTIC� TANK,. -_ GAL ACTUAL LEACHING AR A E RrQUIREMENTS " SIDEWALL1 AREA GAL�/S,f.' _ BOTTOM AREA GAL '(BOTTOM SIDEWALL) �,:�u GAL . PERCOLATION 496' -: T .801L EST." . LEACHING CAPA CITY. 2. + 1T 'DATE, OF SOIL Tr 12 '90�GA 24 2 L 2- -/2) 0 'TEST 5o�4 R SER E VEI-LEAMNG :CAPACITY- - WITNESSED: B SAME , :rc __PtRCOL ATION TION -HOLE , 1 --OBSERVATI HOLE�� 2 OBSERVA�ro ELEV. ELEV. REAKOUT,1CALCULATION -0.00 0.00 -OT4( -roi- i Sb?�SolLo '(Zl q b o F LEGEND: looxo' EXISTING SPOT ELEVATION EXISTING CONTOUR-------00-- A, FINAL SPOT ELEVATION 00,0 L FINAL CONTOUR _u . ..... LEV. SO4L TEST 'PIT LOCATION �AT ELEV.,:'i HO-WATER WATER :,AT E 'TOWN WATE -W--W- R SEP TIC TANK,, �7 DISTRIBUTION BOX 0 Z6 060 :5F� TER :: LEVEL ADJUSTMENT: A RIMARY LEACHING PIT �o p RESERVE- LEACHING PIT TEST DATE WA INDEX WELL WA I INITIAL ISSUE L TO LEVEL ANGE ZONE -FOR- tNDtX WELL� ' , NO. DATE DESCRIPTION DEPTH,T0 WATER LEVEL -FOR THIS MONTH 'DESIG-N 'T PTIC N ,, SE WATER LEVEL 'AOJUSTMENT . DEPTH -'TO HIGH .WATER 5LL)r,- IN S BARNSTABLE .`MASSACHU ETTS FOR , Iq V CO.' Nc. GREENBRIER DV ELOPMENT A SCALL.- - 'jbB NO.� -:1472 AP bVED: BOARD OF ' H ALTH PR 'IN ::,"'PLAN S OC TE S C F I. WAGNER S IA gmv�m umin am= :RAM TA*W CENT V= UA 02632: 89 EST MAiN 'STM7r ' r TCH 4. P fflDAlI()N L OR rT 4� - I I AWO ST