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HomeMy WebLinkAbout1402 BUMPS RIVER ROAD - Health 1402, Bumps River Road"',, ' - r t Centerville A 188 051 SIII. 1__JI vs�►�t�o`�r� UPC 10259 No.HH16 OR 4 4w HASTINGS.ION t PARCEL ` �5 -.,,� NOV 1 U 2004 !�: a- ""' TOWN OF BARNsTABLE DATE 11/O 1�,0 4 HEALTH DEPT. PROPERTY ADDRESS 1402 3umoz / .ivea Rd.- w x Cent eay.ii.ee, Ma. 02632 On the above.date, the.septic.system at the address 'above was Inspected. This system consists of the following: 1. 1-1500 ga.P.2on 3e/2t.ic tank. 2. 1-di,,t/z.igut.ion &ox.' 3.•8-.in�i.etaat0z-6. tw0 aow.s of 4 ( 33'x11 ' ) Based on inspection, I certify the following conditions: 4.,7h.la 1.3 a t.itie dive 6912t.ic 13ybtem.' 5.t7he zept.ic hyztem .iz .in pnopea woak.ing oadea at the paezent time-' SIGNATURE Name: Robert A. Paolini Company: Joseph P Macomber-& Son Inc., Address: P. O. Box 66 Centerville, Mass 02632 Phone: 508-775-3338 or 508-775-6412 JOSEPH P. MACOMBER & SON, INC.. Tanks-Cesspools-Leachfields Pumped &.Installed Town Sewer Connections P.O. Box 66 Centerville, M. A 02632-0066 775-3338 775-6412 • COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIItp'NKP;4 NTAL AFFAIRS DEPARRTMENT OF +jNVI1.QNMRNTAL pROTUTION d , Y TITLE 5 OFFICIAL INSPECTION FORM—.NAT.:EOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION Property Address: ..1402 BufflRz Riveiz Rd. Leaf oIzu! Ua, as Owner's Name: �04a Inn d Owner's Address: Same, Date of Inspection: 10/2 9 Name of Inspector: (please print)R o a e2 t /ct a ein i_ Company Name: � , P. lBacoa ek & .S_Q_ Zrzc. Mailing.Address: en eay.c e, 8ab a.•02632 Telephone Number; 5 0 8-7 7 :3 3 3 8 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-Title 5(31b CMR•15:000). Tile system: XXX Passes Conditionally Passes Needs Further Evaluation.by the Local Approving.Authority ails 's Si re: Qr ' Dater Inspector gn.The system inspector shall submit a copy of this inspection reporCto the-Approving Authority.(Board of Health or DEP)within 30 days of completing this inspection.If the system:as.a,shaved system or has a design flow of 10,000 gpd or grester, the inspector and the system owner.shall�submit the report to the appropriate regional,offfiee of the DEP.The original should be sent to the system owner ana copies sent to the buyer,if applicable,and the approving. authority. Notes and Comments ****This report only describes conditions at the time of inspectiotrand 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. nacre Page 2 of 11 OFFICIAL INSPECTION:FORM—.NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOIE PART-A CERTIFICATION(continued) Property Address: 140.2 i?„wP A ?l>>o a ?d Confnn>> i OO.g,� (rfU owner: Date of.inspection: 10 5/0 4 Inspection S.um`mary: Chit& A,B C,D or.E/ALWAYS�comprleteall of Section.D A. System Passes: no 1 have not found any information which indibates`that any of the failure criteria described in 310 CMR 5—.303.or in 310 CMR 15.304 exist..Any failure criteria not evaluated are indicated below. Comments: The .32Qtia .suAf m iA 1a 4anpon moo? ina nnr/'oa al lho fono.tonl limp-, B. System Conditionally Passes: no 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 o. • The septic tank is metal and.over20 years old*or the septic-tank(whether metal.or not)is tractural)y unsound;exhibits substantial infiltration or exfiltration.or tank failure'is•:in mineni. 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: no 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 broker,settled.or uneven distribution box.System will pass inspection.if(with approval of Board of Health): broken.pipe(s).are replaced. . obstruction is removed 'distribiltionbox is levelod'or.teplaced ND explain: n o 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 explaire Page 3 of 11 O�'iCIAL INFECTION FORM-NOT,VORSYSTEM�iSP`R �N EORN�s-SMENTS --� SUBkWACE SEWAGE DISROSAL PART A . . CERT-MCA-MON(toritinued) : Property Ad dress: 1402 Bumph /2ivea Rd., �e2v�..� e a•' Owner:. !z r/ Date of inspection: 1►�/"� C. Further Evaluation-is Required by the Board of Health: �Q Conditions.exist which.requirther..evaluationbi.theBoard:of-,Health;in•order.:to-,determine ifthesystem e fur is failing to protect public•healthy.safety. or the environm 1. System will Pass unless Board of Hein detervines4h accordance with 310.CMR 15:30 1 b that the system is not functioning tin.a•manner which-will-protect public health,safety an¢•the',taviropment: Cesspool or privy is within,50 feet of asurface water �p 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 Af any),determines that the system is functioning in a mariner that protiets thepablic health,safety and environment: noThe system has a septic tahk and soil absorption system•(SA•S).:and the SAS is within 100 fe.et.ofa surface water supply or.-tributary to a.surface water supply. The system-has•a.septic tank and SAS and the:SAS is!w•itlxin a Zone 1 of a-public wateresupply. rz o. -the SAS is vuitltinSSO feet of a private water.supply well. The system has a septic tank ano.W:an n oo The system has aseptic tazrk and SAS and the?SAS is less than 100 feet.biit 50 feet OF, ore 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 arnmonia 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: Page 4 of 11 OFFICIAL-INSPECTION FORM-NOTFOR;VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address:1 4 0 2 13umpA 1?i*,)oq i?d., (•onfon)liDDo Pln_-- Owner: 2 n I-,n kL—.ad Date of Inspection: D. System Failure Criteria applicable to all systems:. You must.indicate."yes"or"no"to.each.ofthe:following:for allinspectio= Yes No x. Backup.of sewgga:into fatAiry or=systeT-component due_to overloaded:or clogged SAS...or.cesspool z Discharge:or ponding of effluent to thm surface of the..gound 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 nverlbaded or clogged SAS or —' cesspool ' x Liquid depth in-cesspool is less than.6"below invert or.available volume is less than'Wday flow Required pumping more•than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of tunes pumped 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:ofa cesspool-or privy is within a:Zone l ofa,public.well.. z 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-.titan 51D 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 colifornt bacteria and volatile organic.compounds -Indicates:that the well is.free from pollutlow.from:tl 01hellity 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.) a o (Yes/No)The system fails.I have determined that one or.morerof..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 convect the failure. E. Large Systems: -To be considered a large system the:system must.serve.a-faeility,with-a design flow of 10,00.0 gpd to 15t000. 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 ate(1pterim 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 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS �. gif$SURFACE-SEWAGE DISPOSAUSYSTEM INSPECTION FORM PART B 'CHECKLIST Property Address: 9 L.n7' /3iimr A /?i»on Pd.- Owner: � �ad Date of Inspectiotr rl ,ti;i�L.i Check if the following have been done You trust indicate"yes"or"ne alto each.of the following: Yes No .,i• — pumping information-was provided'by the dwner,occupant,or Board-of Health _ x Were any of the system components pumped out in the previous two weeks 7 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 th sinspection? x _ Were as built plans of-he system,obtained and examined?(If they were not available:bote ss N/A) x Was the facility.or•dwelling inspected for signs of sewage back up 7 — — , Was the site inspected for signs of break out 7 x• _ Were all system components,excluding the SAS;located on site.? x _ Were the septic tank manholes uncovered;,Dpened;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 Aepth 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 detered based on: Yes no . . I 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 approxnnetiomof distant CMR 15.302(3)(b)] is unacceptable)[310 i i Page 6 of 11 OFFICCIAL U14SPTCTIOUN;FA M-NOT FOR VOLUNTARY ASSESSMNTS SUBSUIMACE-91MAGE OIROSAL SYSTEM,INSPEMON:FORM PART.0 SYSTEM-INFORMATION Property Address: 14 02 /3uml2 s R ive2 Rd., Ceni-eay.iiie. Pla., Owner: Zn h n- U n n d Date of Inspection:1 n/P 5.,/Q FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design:-,,4...; .Number ofbedrooms.•(actual): 4 DESIGNflow-based on`310 C1VT1 15.205*:(for exainpYe:'110'gpd z#-ofbedroomsy: 4x4 1.10.4 4 0 gl2d Number of current residents:-.: Does4esidence have a garbage grinder(yes br rip):n n Is laundry on a separate sewage.sysiem•(yes or.no), [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use!(yes or no): n o Water meter readings,if available(last 2 years usage(gpd)): o14p �. I �p�©�' �)Oy S?j Sump pum (Yes or no):,, Last date of occupancy: R,,?,z A o n f ° r' COMMERCI;kk -- USTRIA•L ' Type of esta>a t: na, DesiPgn flaw. on310 CMR 15.203): na apd Basis.ofdMi %n'flow(seats/persons/sq%etc.): na Grease trap�present(yes or no): n n Industrial waste holding tank present-(yes or no):r Non-sanitary waste discharged to the Title 5 system-(yes or no): as Water.meter readings,if available: Last date of oecupancy/use: . n n. OTHER(describe), . GENERAL INFQRIYI(ATION ". Pumping Records Source of information: 12.,% Macom&e2 and .son Was system pumped as part of the inspection(yes or no):nn If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for.pumping: a u m R e d tank. 10/11/0 2 TYPE OF`SYSTEM o Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if in;y) _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): Approximate age of al]components,date installed(if known)and source of information: 9115195 Were sewage odors detected when arriving at the site(yes or no):,� Page 7 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A PART C SYSTEM INFORMATION(continued) Property Address: 1402 Bumlzz R ive2 Rd., C n_nfv2yi LPe. Iva., Owner: 9 n h n hl a n d Date of Inspection: 1 ELT 5 LQ 4 BUILDING SEWER(locate on site plan) Depth below grade: 15". Materials of construction:_cast iron x 40 PVC_other(explain): Distance from private water suppy wej or auction line: 10' + Comments(on condition of joints,venting,evidence o€leaksge,etc.): lo.intz appeal tight.-No Pv.idence o�e .geakage System vented th2ough house ventz., SEPTIC TANK:_(locate on site plan) Depth below grade: 1 ' Material of construction:Xconcrete_metal_fiberglass polyethylene _other(explain) _ If tank is•metal list age: n o Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 10' 6"i o n a/5 ' 8"w.id e/5' 7"g.i gh Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:I ' 11" Scum thickness: 5" 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: 2 How were dimensions determined.• Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integaty,liquid levels as related to outlet invert,evidence of leakage,etc,): t teez a/te .in /2.2ace., oz, aka e.• GREASE TRAPya­(locate on site plan) Depth below grade:..n a Material of construction: concrete_metal_fiberglass_polyethylene other (explain): n as Dimensions: an Scum thickness: „Q Distance from top of scum to top of outlet tee or baffiena Distance from bottom of scum to bottom of outlet tee or-baffle: n a Date of last pumping: n a Continents(on pumping recommendations,inlet and outlet tee or baffie condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): �non.ty t'nnl? nol R2eisent - + Title S TnenP�tinn Fnrrn(./1 ShMl1 7 Page 8 of 1 I OFY♦ICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS %V-RF;A;CE SEWAGE DISPOSAL SYSTEM INSPECTION FORK! PART C• SYSTEM INFORMATION(continued) Property Address:1402 Bump� /2M�ve2 /2d. Owner: ?-,An 410orl . Date of I•bo p-ectlon: 1012 5 0 Z TIGHT or HQLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth be)ow grade: na Material of construction: concrete metal fiberglass_—polyethylene other(explain): Dimensions: n a _ -. _.. . ... Capacity: na gallons Design Flow: n n gallons/day Alarm present(yes or no):n�_ Alarm level: Alarm. working-order(yes or no): n.n Date of last pumping: n n Comments(condition of alarm and float-switches;e'^.): 1 02.J �.cl ny .tca 14--?0 12*t.s P-41_ DISTRIBUTION BOX y."_(if present must be opebod)(locate on site plan) Depth of liquid level above outlet invert: ao 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.): dnx hn t f��n Onfonnl�:t N�nuidnncP rQ.Z. egakage into 02 ..„� nO 0 p 410 -46[JZrt6 4 �n0;rl� �nnniin»on_ - PUMP CHAMBER: nn(locate on sife.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.): aum,2 cham&ea ao-t aae'sen.t 8. Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY AS; ESWENTS f-. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress:y�402 Rum,nA i?1»nn Rd., '�onfon»j OOp.� lyl�i_ Owner• Date of nspection: 9 0/2 5/0 4 SOIL ABSORPTION SYSTEM(SAS): {locate on site plan,excavation n'ot-required) If SAS not located explain why: foraged .toe agge 10 Type leaching pits,number:_ yes leaching chambers,number:_ R in�i_ft2atoaz 2 /tow,3 o� 4 33'x1 / ' each 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.): .so.i.ez a/2/2ea2 day No .3.ipns o� hyd2au�ic ,�ac�r�2e. Ve eta.tion appeaaz ho/tmae., CESSPOOLS:��_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: na Depth—top of liquid to inlet invert: rn a Depth of solids layer: n-n Depth of scum layer: na Dimensions of cesspool: na 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.): / ._ 04A/2no.EA no;t luzz.Apni -- PRIVY: no (locate on site plan) Materials of construction: na Dimensions: na Depth of solids: na ® " " Comments(note condition of soil,signs of hydraulic failure,level of*ponding,condition of vegetation,etc.): nnf y 1?cAanf - Page 10 of 1-1 Op C .Y�tEPE 3'IQN' O� VI�* O'�-,FOP.•' -O'T.�1< W.A3t AS3Es9NXNTS / SII�Sil�A�`SE�A6E��SrEOS��SYS�EA�.INSLEMON•:FOR1Vf I PAR' SYSTEM PgORMAUON(montimed) Property Address: 14 0 2 Hum 12,6 12. n �� ( onfonu 0.Oo A]n Owner: Date oil n/�"5 n^•" SKETCH OF SEWAGE•DI5POSA,L SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanelit r�efar�nae 101 arks or benchmarks.Locate all wells w}thin 100 feet.Locate where public voter supply enters.the building. r � 13 o 10 Page 11 of 11 CIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMEN FORM TS OSUgSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PART C SYSTEM INFORMATION(continued) Address:' n 3 U �.t / i 2) /2d,' Property i (' ' nnni00o 1�1n_ _ Owner: Date of spection: L�Q � SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water ��J feet ` Please indicate(check)all methods used to determine the high ground water elevation: QJ obtained from system design plans on record f design nj plan Mviewed: observed site(abutting property/observation hole within 1 0 feet a Checked with local Board of Health-explain: Checked:with local excavators,installers-( o ch documea IL ntatt a P,-e e-. a h m a., u e z Accessed USGS database=explainf� /� r—, You must describe how you established the lh 1 h gr u1 d water elevation: used;Gahert & Miller mo used'USGS observation w 1 used- Technical bull — — wa er a eva ions. of 33 eet Groundwater: Feet Below.Bottom•of Pit 14igh Groundwater Adjustment 1.8 ft per)TirnQte�Method Therefore,the.vertical.separation distance between the bottom of the leaching pit and the adjusted groundwater table is/?V- i feet: 11 ~ WY); •m•nrnr—nrts+—T+"TR�mr•nenlre�nitasnrrtrr lU N OF *'m`-�• �* BOARD OF 11E�ALTI1 +. SIJE)SU[d`FACF SEWAGE D18POSAL SYSTEM INSPECTION FORM - PART DR CERI�P, FICATI0N,rl. T j ••t'••1•T•:'::tom�•117.".T.T,T77:11'fIRSfTt1�7RS1ltl�lr�1.'I'rIITYR�1RSliC1� �s -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED , STREET ADDRESS 1402 Bum h Rive2 Rd.- ASSESSORS MAP , BkoCK AND PARCEL # , OWNER' s NAME aohrz wood. PART' D CERTIFICATION d2.o ?a4 f NAME OF INSPECTOR erl COMPANY NAME Joseph P. Macomber &*Mon COMPANY ADDRESS BBoox_66 Cent A 021953 Town or city state LIP Street COMPANY TELEPHONE ( 508 775 3338 FAX 508 . 7 0 1578 „ CERTIFICATION STATEMENT I certify that I have personally .inspecteeded ithe sewage distegaansystem at this address and t11at t)i.e information rTherinspection was perfo:r.med and any omplete as of the time of �inspection recommendations regarding upgrade , maintenance , thenproperefunctionpair are and maintenance ofon- with my 'tvainih.g and experience site sewage disposal systems 'Check one: V. System PASSED The inspection %ghich I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR. 16 , 303 ► Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this. form . System FAILED* The inspection which I have coy toted has found that the system fails t protect, the ��ublic health and the environment in accordance with Title pro 5 , tec CMR 151303 , and as specifically noted on PART�C -JAILURE CRITERIA of this inspection form . / t Inspector Signature' `- Date ne copy of this certification must •be provided 'to the OWNER, the BUYER (where applicable ) and they DOARD OP` HEALTH, . * If the inspection FAILED , the owner or operator shall, up.grade ' the eyetem. within o•ne year of the eidate of the inspection., unless allowed or requi,>?ed otherwise as Providedpartd .d( _ r t � , 4Y t r,6 ` tiV r �t rt r :ti ,' ..1 4+ .vt. t r, 5 l tr. 3 a' :5 aql, J'.. },; ':1. 4s} f 4 a' s s 5 ro - 'i: ,l t- t, ,: aR t ..t l _ s f r 5'" .,.7. `, 7 r 1 Y 4 ,. ,.:. ::ri: ,.:r Alit. . ,a < l , $ yr _Y-. ,ms" ti �, Y, , .,.. t :v .to- :._. t.' -. ..rF...,....,.,,, �;tr 1Y r.. >„ ,,�", is z', :Y,. 11. s v:.. :... .: 1r.,,.1 t. s;.- :, !"., :,ar ,\ !,,� •'e:E to.. ,of ,t -r:1g 5 x t,.,,`: r ..,H 1) :41 r ,a. 3 a ,'. a. r.:, ':., ....cpl :.,' ..,., M , '.;A >a ,i A - .,t 1. t ' -r .y..u. r...:.: _ .s.. ..,. ;_ ..1., -'v, .,�.,Y R J,a.:': ....>s e .t �" +.� J, q. x;� `t igloot.:: o.t., 1 ,f. .ti, Ya- :.a .�. �..�,s. 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':ix:.`E ti '!a:,, :3 ', ; T <L { -E vy.>+ ,&r x sw,jjt,l -:;i '4i .is r. ` '~,i.r aft , ..x v a DATE : 1 0/11 /02 PROPERTY ADDRESS:1402 Bumps_River Raod--- Centerville,Mass . �s ------------------------ 02632 ------------------------ � �-- On the above date, I inspected the septic system at the abovesa-d-d-res-s This system consists of the following: WECOVED 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. OCT 3 1 2002 3. 8-infiltrators. Two rows of 4 ( 33 'X11 ' ) TOWN OF BARNSTABLE Based on my inspection, I certify the following conditions: HEALTH DEPT. 4 . This is a title five septic system. 5. The septic system is in proper working order at the present time. 6. Pumped the septic tank at time of inspection. Heavy scum & solids layers were present. SIGNAT / Name :- J . P . Macomber Jr . --------------------- Corripany : Josgeh P�_ Macomber & Son , Inc . Address :__Bq; _6� __-__----_-_ -_ can-t.erv-�L11gt,_ba--Q.2_632-0066 Phone: 508- 775- 3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY mambo ey JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632 0066 775-3338 775.6412 �a -\ COMM 0NTWEALTH OF IVJASSACHUSETTS DIJW , EXECUTFr✓ OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE S OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Propert) Address: 1402 Bumps River Road Centt-rvillP Maser Owner's Name:Margaret Wood Owner's Address.10/11 /02 Date of Inspection:Same Name of Inspector: (please print) Joseph P. Macomber Jr. Company Name: J. P . Macomber & Sons Inc Mailing Address: Box 66 C'PntPrvillP Ma 2632 Telephone Number: 508-775-3338 CERTIFICATION'' STATENIE:\'T I certtfj that I have personally unspected the sewe.ge 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 ,ratnoe and experience in the proper runction 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: Passes Condi,ionally Passes , Feeds Funher Evaluation by the Local Approving Authoriry Fails Inspector's Signature: Date: The system inspector shal ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. I f the system is a shared system or has a design now of 10,000 gpd or greater, the inspector and the sys.:m owner shall submit the repon to the appropriate regional office of the DEP. The origunal should be sent to the sys:em owner and copies sent to the buyer, ifapplicable, and the approving au(horir). Notes and Comments ••"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. I i Title 5 Inspection Form 6/15!1000 page I Page 2 of 1 1 it OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:1402 Bumps River Road en ervi e,Mass . Owner: Margaret Wood Date of Inspection: 10 11 0 2 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: Vd 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: ThP CP1ltlr SVGfPm is in proper Working order at the preS911+6 t i mo B. System Conditionally Passes: _Ve) 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. Z 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: 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 ND explain: 2 Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 402 Bumps River Road t^PnttPrvi 1 1 P, Mass_ Owner: Margaret Wn.(j Date of lospection: j() /1 /n, 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 wbich will protect public bealth,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: &6— The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. 40 The system has a septic tarty, and SAS and the SAS is within a Zone 1 of a public water supply. A0 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 I OQ feet bu} 0 feet or more from a private water supply-%veil'•. 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: AA 3 Page 4 of I I OFFICIAL. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:1 402 Bumps River Road Centerville,Mass. Owner:Margaret wood Date of Inspection: if)11 1 /()2 D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections: Yes No _ Discharge ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ,clogged SAS or cesspool 4/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool �,tJd�%1`iflc+t�� x-.low-;; ot, // /Liquid depth in c4"pQ-94 is less than 6" below invert or available volume is less than 'h day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number fumes pumped �. �ny portion of the SAS, cesspool or privy is below high ground water elevation. y ponion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface /water supply. r//Any portion of a cesspool or privy is within a Zone I of a public well. d . portion of a cesspool or privy is within 50 feet of a private water supply well. 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. (Tbis system passes if the well water analysis, perlormed 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.) 111 (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 or 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 now 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) des no the system is within 400 feet of a surface drinking water supply the ysiem 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" to 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 1 5 304 The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL. SEWAGE DISPOOAL O STEM INSPECTION FORM SUBSURFACE PART B CHECKLIST Properry Address: 1 402 Bump Ri vP*--Road Cen Owner. Margaret- Wjao4 Datc of lospecIioo: 1 011 1 /n2 Check if the following have been done. You must indicate "yes 11 or"no" as to each of the following: Yes N*o �Pumpung 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 ? 2Have large volumes of water been introduced to the system recently or as pan 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 componentsiikluding the SAS, located on site ? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition Krm/e7affles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ' ..� Was the facility owner (and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on Yes no _ Y Existing information. For example, a plan at the Board of Health. Determincd'in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CM.R 15.302(3)(b)) 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1402 Bumps River Road Centerville,Mass . Owner:Margaret Wood Date of Inspection: 1 0/1 1 /0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms (actual): DESIGN flow based on 310 C 15.203 (for example: 110 gpd x M of bedrooms): X��-�y����� Number of current residents: Does residence have a garbage grinder(yes or no): .PJ[1 Is laundry on a separate sewage system�ye or no):� (if yes separate inspection required) Laundry system inspected (yes or no): � Seasonal use: (yes or no):4Z Water meter readings, if available(last 2 years usage(gpd)):2 0 0 0—9 1 , 000 gallons=249. 32 GPD Sump pump(yes or no): &Z I — gallons=265. 76 GPD Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment-. Design flow(based on 310 CMR 15.203): ffnd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):/19 Non-sanitary waste discharged to the Title 5 syste (yes or no):Iex Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as partp�f the inspection (yes or no): X&15� If yes, volume pu mped:,,Veb gallons -- How was quantity pumped determined? lr ✓C1/' Reason for pumping:Heavy Scum & solids lavers were present. TYP VOF 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 o tained from system owner) ight tank /� Attach a copy of the DEP approval /rL Other(describe): pprox im a e age,of all pgWoWnts da installed (if known nd ource of information: Were sewage odors detected when arriving at the site (yes or no): eh 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1402 Bumps River Road Owner: MargarPf Wnnrj Date of Inspection:1 n /1 I /n 9 BUILDING SEWER(locate on site plan) Depth below grade: 4 Materials of construction: cast iron 240 PVC,!116other(explain): Distance from private water supply well or suction.line: ,d'f Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of leakage.The system is vented through the house vents. SEPTIC TANK: Zlocate on site plan) Depth below grade: /aN � Material of construction: —/concrete,G.P metal/f fiberglass�e/e)polyethylene i dbther(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance (yes or no):,L0(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: (f!) Scum thickness: _r) 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: C— How!vere dimensions determined:Pumped tank at time of inspection. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage, etc.): Pump the septic tank every 2-3 years . Inlet & outlet teesw are in place.The tank is structurally sound and shows no evidence of leakage. GREASE TRAPA+_,4e(locate on site plan) Depth below grade: C// Material of construction: concrete/&metal4fiberglass4�jpolyethyIene41Aother (explain): AM Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: elm Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 4/,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.): rrt-aGa trap i s not- present- _ 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1 402 Bumps River Road Centerville ,Mass, Owner: MZrgarat wnnrl Date of Inspection: 1 1 1 1()2 TIGHT or HOLDING TANKel �(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: 11)11 Material of construction: AA concrete,()/! metal *4 fiberglass &k2 polyethylene A)V other(explain): AM Dimensions: Al.A Capacity: /pJ gallons Design Flow: gallons/day Alarm present(yes or no):_A Alarm level: A7,4 Alarm in working order(yes or no):yam, Date of last pumping: —� Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present DISTRIBUTION BOX: /if resent must be o ened locate on site plan) P P )( P ) Depth of liquid level above outlet invert: AV Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has two laterals No evidence of solids carry ntar Na evidence of leakage into or out of the box PUMP CHAMBEROd4M,_(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.): plim rhamhar i c nnt- nrpspnt 8 Page 9 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:1 402 Bumps River Road Centerville,Mass. Owner: Margaret Wood Date of Inspection: 10/11 /0 2 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) 2—rows of 4—infiltrators . ( 331X11 ' ) If SAS not located explain why: Located: See page 10 Type �D leaching pits, number: ii t leaching chambers, number: a'll# 4,,10 leaching galleries, number: 0 W0 leaching trenches, number, length: _ Q leaching fields, number, dimensions: W overflow cesspool, number:d Ab innovative/alternative system Type/name of technology:j�r�� � Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): T-narnv -and o boney fine sand No signs of hydraulic failure nr ronridi na Rni 1 s are dry Vegetation is normal 1 -row 2" waste water one row is dry. CESSPOOLSW,40t; (cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: itJA Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: �(f Indication of groundwater inflow(yes or no): AA Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): C.e.s-S-AAnI c aro__ not i rrmcr�nt PRIVY(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Pr nn+- present 9 I � 0 1 � �I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �i��nstt1 �I`durk.� �nn,�fa urfi�n ��rmit Permission is hereby granted. .,.i?,..E'7� �,. �..z ..1�............................................................................................... to Construct ,( ) or Repair,� ;r,`� an Individual Sewage Disposal System at No..........:r.v' 3c .�I;a 1?�t,v_2 ,2:%.�1. zrz.t o_.c �11�e ........ ..................n....-- ------............... ............................... .. .. str"t as shown on the application for Disposal Works Construction Permit W ............... ....... ..... ................................... DATE............. BQaxd�6f-Hea ..... /.�-..-................-.-------- FORM 36500 HOBBS Q WARREN.INC.,PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifi ate of (�ompliancP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedX vX:'i) y ............... .. ......I............................ _......._. .............. .......... imuii•., at ................1.402.....U,r./2-s....24v"2 J?o"d d er t:�2�.•� F.ec- _.... ................................................................................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental C d as cribed in the application for Disposal Works Construction Permit No. .... --�..�.(y dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARACNTEE THAT THE SYSTEM ILL FUNCTION_SATI CT RY. DATE ........._.'"'._..... ...................... ._............._. Inspect _........... ....... ........ Yv.................... iC%�� ➢IV 10 of I I OFFIC!Ai IN"CCTION FORM-- NOT FOR VOLUNTA-RY ASSESSME'.NrS S065t) "'CC SEWAGE DISPOS,, SYSTEM INSPEC"T'ION FOR.�v PART C SYSTEM INPORh1ATION (conclnVco) ➢,�, ,� ,,o,,, 1402 Bumps River Raod Cen ervi e, . s. 0 -P,-tr—cF ,-e t �T n o d 7rit 711n,pcti�00: SiCcr( H Qr SEw�CC DISPC) ,AL SYSTEM Ao„oc ci,icn olrnc tr o;,poi,l lrlrcm Inclv4ln` Uc1 io tl"""'A 100 (cri lll fwpPcrm ntrtf tnt <rcncc Itn ^�Nnvti loco c ru ,ri, . loccrc wncrt public Ic lc t c IVPPIY cnlcrt the wiloinl Cmrr�, ; e rr I �►�fl2 a4.w1P5 ���Gf I�.oac� �htcn'vr��P (fir i62( OT ltv}t i 10 Page I I of I 1 p OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1 402 Bumps River Raod en ervi e,Mass. Owner:Margaret Woo Date of Inspection: 1 0 1 1 0 2 SITE EXAM Slope Surface water Check cellar Shallow wells f Estimated depth to ground water feet Please indicate (check)all methods used to determine the high ground water elevation: YES Obtained from system design plans on record - If checked, date of design plan reviewed: 10/11 /0 2 YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: NA YES Checked with local excavators, installers- (attach documentation) YFS Accessed USGS database-explain: http; //town barnstable,ma.us. You must describe how you established the high ground water elevation: Jsed: Gahrety & Miller Mod _l - 1 /16/ 4 Ground water elevations above sea level - Jsed: USGS; Observation well data Tune 1992 Jsed: USGS;' rl 1 eti n 99.00n_1 pl ate #2 Annual ranges c)f 2round water elevations .January 1992 7� :eet Two rows of four in iltrators, 33 ' X11 ' 0, Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore, the vertical separation distance between the botto Of the leaching pit and the adjusted groundwater table is feet. 11 r r , `` ..r-,r+.-n i rr—•+-+-i'•r.-a+•r.•n m rr..r..-�r.rr.r.:-.'r,-.-ram.*:-rrr-rr m--•v r*c-v-n.rn- .. 'FONN OF Barnstable WARD OF HEALTH SMISURFACF SFHAGF I)ISF'OSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I r... r ...-r., ..---r.r..-m•n.r-ri ran-.rr+rrr•rr•.r-•.n-si-+,-s r'mr�-r-r.c�-rc'+r.mmrsmrr< mnn�mrrrrito•+*r•r+*++�.•.:r-rr- r•�. -. A -TYPt OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 1402 Bumps River Road Centerville,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME blarcrarat- Wnnrl PART D - CEI?TIFICATION I NAME OF INSPECTOR Joseph P . Macomber Jr COMPANY NAME Joseph P. Macomber &''"Son Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or City state tIP COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 ) 790-1-578 CrRTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at ®rlecommenda his address and that the information reported is true , accurate , and omplete as of the time of , inspection , The inspection was performed and any tions regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one , ' System PASSED The inspection tghich I have conducted has not found any information which indicates that the system fails to adequately protect public h0R1t)i or Lhe. environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have condlcted has found that the system fails to. Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur rt Date �''44a- Onecopy of this rt.ification must be provided to the OWNER, the BUYER where applicable ) and the BOARD QF HEAL'1'It , • If the inspection FAILED , the owner or 'oparator shall upgrade ' the ayatem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CPIR 16 , 305 . partd . doc ASSESSORSMAPM J PARCELK DATE: 7/2.0/ 4 5 -- lb PROPERTY ADDRESS:-1402 Bumps River _Road Centervi -- Ce-ntervi-lle T On the above date, I Inspected the septic system at the above ad8 �---- This system consists of the following: 1 . 1-61x6 ' block cesspool . Based on my Insertion, I certify the following conditions: 1 . This is not a title five septic system. 2 . Cesspool is .full and has overflowed . 3 . Cesspool is presently full and beginningto cave in. 4 . Heavy vegetation growth all around cesspool . 5 . The sewage system is in failure . 5. System should be upgraded to a title five septic system. SIGNATURF77 !. . Name:_J P Mac&mber Jr,._______ i Company: J_:12_Macomber. &_Son .'Iric'.; Address: Box 66 --Cente�rvi'll,e LMas'sj' -02 3�)�� �. . ..� ..� ( �. Phone:---508=_775_333'8_ - ' THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY vvvvim JOSEPH P. MACOMBER & SON, INC. Tanks+Cesspools-Leachfleld: . Pumped & installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM Address of property 1402 Bumps River Road Centerville ,Mass . Owner's name Nancy Steen Date of Inspection 7/20/95 PART A CHECKLIST Chec if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two wee ks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not vailable with N/A. e facility2. h or dwelling was inspected for signs of sewage back-up. / The site was inspected for signs of breakout. V All system components, excluding the SAS, have been located on the site. G'es� eat The manholes were uncovered, opened, and the interior of the septic t was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. I/The size and location of the SAS on the site has been determined based n existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance '.of SSDS.' Recommendations 1 . Pump fill in cesspool 2 . Install new title five septic system. 3 , Do nut install garbage disposal . f a ' g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ` SYSTEM INFORMATION ) FLOW CONDITIONS If residential �J number of bedrooms O number of current residents garbage grinder, yes or no, laundry connected to system, yes or no . � seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: 1993=211 , 000=GPD=578. 08 1994=72 , 000 gallons=GPD=197 . 26 Last date of occupancy GENERAL INFORMATION Pumping records and s urce f information: A a ens.A►i t�; ,.��►,dd System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system A Septic tank/distribution box/soil absorption system Single cesspool -AJ0 Overflow cesspool AIQ Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) ' _Ida Other (explain) Approximate age 'of all components. Date installed, if known. Source of information: /P I Sewage odors detected when arriving at the site , yes or no 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) :XXXX (locate on site plan, if possible ; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number 1-6 ' x6 ' block cesspool . Comments: (note condition -of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) Sand & Gravel ; hydraulic failure and ponding around cesspool . Large growth ot vegetation. Recommendation. Fump fill In cesspool install new tit e tive septic system. CESSPOOLS (locate on site plan) : number and configuration 1-6 ' x6 ' block;`._ cesspool , depth-top of liquid to inlet invert Over invert depth of solids layer None depth of scum layer NONE dimensions of cesspool 6 ' x6_' Co materials of construction ncrete Block indication of groundwater None inflow (cesspool must be pumped as part of inspection) Not pumped , Failed has no Comments : Occupants . (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) Sewage system in failure . Must be upgraded to:•.a title .five septic system. PRIVY : (locate on site plan) '' materials of construction dimensions NONE depth of solids Comments : (note c•onditi(. of soil , signs of hydraulic Failure, level cf 'pond ng, cond i , .r-i of tatio'n , _=me_�dations A ;naintenar; repai ­ , etc. ) . r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ,FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Town Water f O )De i ►'JO . 1 v « 2� er • DEPTH- TO GROUNDWATER 20 '+ depth to groundwater method •of determination or approximation: , I_nst'alled system ri lot beside this pruperc'y; ug es Fo e 4 ' to water from the bottom of the SA r , 1 J•�t:�^..TiL'TT.SC—LT IT....TCTTS��z3iL'T.iTCa.'T3�S4tTiTSSiT"'+Y�LST.3CsiCLTt.- .. TOWN OF Barnstable BOARD OF HEALTH + ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION �:r.:r.9LLaetis YiT.t is«LT-ritiRLJfCtiSIS'RTr�CTi1pS1{sW.+3L•itrSSJa3ayflaATL'—.23ST7:aLQ'• -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRUS ItQ2 BumDS River Road C.ente ville .Mass ASSESSORS MAP, BLOCK AND PARCEL # 1AR_51 OWNER' s NAME PART D - CERTIFICATION NAME OF INSPECTOR J P Macomber Jr COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville Mass . 02632-0066 Street Town or City State ZIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa-1 system at this address and that the information reported is true, accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- s ite sewage disposal systems . Check one : System PASSED The inspection which I have conducted has not found any information which indicates that .the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated; are as stated in the FAILURE CRITERIA section of this form. XXXX System FAILED* The inspection which I` have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature - • Date 7 2t/95 :L�----•ter • One copy of this certification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTI{. * If the inspection FAILED, ; the owner or operato -hall u t within one year of L :�� date"of the insi)cction owed o re system otherwise as >rovid�� .; r ss allowed or iequired f :.n 310 CMR �5 . 3G,J • .doo J ' Water .. , . ....��y Conservation SAVE Tips . . . ME! , . CHECK FOR LEAKS Water Loss in Gallons Due to Leaks Leak this Loss Per Day . Loss Per Month Size 120 3,600 • 360 10,800 • 693 - 20,790 • 1,200 36,000 • 1,920 57,600 3,096- 92,880 0 4,296 .128,980 ® 6,640 199,200. 6,9.84 '• 200,520 8,424 252,720 9,888 296,640 ® 11,324 339,720 12,720 381,600 14,952 448,560 Ccmmcnwearr cr Massc=,,:saris ExecuTrve Gflice cr EnvircnmenTC hffC.,s Department of Environmental Protection Water Pollution Ccnrrol Tecnnlccl Asswcnce and Training Secnons vsnwam F.Weid GOOM W Trudy Cosa SOOWAfy.EOEA Thomas&Powws ac+rq Corrr�...orr 06/12/95 ATTN: Joseph P. Macomber, Jr. Joseph Macomber and Son PO Box 66 Centerville, MA 02632- Dear Joseph P. Macomber, Jr. , I am pleased to inform you that you have attended training, met the experience qualifications rand have passed the Title 5 System Inspector exam, pursuant to 310 CMk. 15 . 340 . The passing grade for the exam was 39/52 or 75%. This is an official notification that you are a Certified Department of Environmental Protection System Inspector pursuant to 310 CMR 15. 340. You will receive a System Inspector certificate at a later date. If you have any futher questions, please write to me at the following address : Kimball Simpson D. E. P. Training Center .5 0 Route 20 Millbury, MA 01527 Thank you very much for your time and consideration in this matter. Sincerely, ��in; •.; Ll T. Simpson, DEP Train�.� per Director (2405� Roue JO •,lillbury, MA 0!'.:7 0 FAX 508-7$5 9253 • '. '06 508-756-7;' ASSESSORS MAP NOL PARCEL No, d /. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinit for Di ipaii tl Works Tnnntrur#inn Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( L41hn Individual Sewage Disposal System at: .... ...... ............. • .........S... Address Or Lot No.......................................... . .. .-..•..-.._...-........... . St . n........-------------------------------------- ............... ...... Address O ncr �� AJ ►-1 Installer Address Type of Building Size Lot............................Sq. feet U6­4 Dwelling— No. of Bedrooms.........3.............................Expansion Attic ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons------.--------------------- Showers ( ) — Cafeteria ( ) a+ Other fixtures ...................................................... W Design Flow..................................tt.. gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity..l.� �gallons Length................ Width...............: Diameter................ Depth................ x Disposal Trench-- No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-1 Percolation Test Results Performed by........ -----------------------------------------•.................---... Date........................................ `j Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit......-:............ Depth to ground water........................ •--•--•-•......................•----•-•------•------------------..........----•••..........-••••-•........................................................... 0 Description of Soil........................................................................................................................................................................ V ----------------•----------------............------.....................-••--•-•--•--•----•......... W ---......-•............................•----.............------....---------- --........--------.........-- 1 UNatur of Repairs or Alterations—,Answer when applicable-. -.••• - . SS -�.. ,tom .... , .... G�..��U Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State-Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comkjance has been ' e board of health. Ala,,:... �s Signed .............................�-.�;... ... ......................................................... ... ... te Application Approved By ` ... �� ........ .......... ........................ ....................cam.' Application Disapproved for the following rearon.r: .:..................................................................................................................................... ................... ...................................................... ........................................ Due Permit No. �✓ Issued ... ....`..... .<�.'- .7 ...................................... ..................... Date -------------------------------- -------------------------------------- -THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#if rate of gomplittnce THIS IS TO CERTIFY, That e Indiu ual Sewage Disposal System constructed ( ) or Repaired bS..�o. .. .........................................�................................................ ......................... Y ............................ at ...........................I.y.Q. .........tJ ...... ... ......14\ )-C,f.......1. (Jr...........rv,.QJ� .V ..I.tQ'............................................................... has been installed In accordance wlth the provisions of TI'fI. o e Sate Environmental Code as described in the application for Disposal Works Construction Permit No. .. ...6....:9. ..... dated .r��'..�z �-..:.'O THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................... ........................................................ Inspector .................................................................................................. .._ ......--- --------------------------.--- THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH l r TOWN OF BARNSTABLE .. � � No........................ FEE._ �in�nnttl nrk� � tt�trnrt��nn �rrmit Permissionis hereby granted----------- ------- ----------••----••-•--•--•`---------••--------- --•-••---------------------------------------.................... i to Construct ( ) or Repair ) an Individual,Sewage Disposal System I ..�..`-`::�..•............................................ at.No---------- ----------•-------•------------------------ �r �;? N1 =�?......... -°t1.......- .............. _ as shown on the application for Disposal Works Construction Per m � /�a�te]d,. �-..•••. . •�•-....../. Board of Health DATE----.... .....-` -.......5.. ----------------------- i FORM 36508 HOBBS R WARREN.INC..PUBLISHERS P No................_....... Fss......._ ._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for 11iripm3al li nrlt,i Towitrur#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair (X 2) an Individual Sewage Disposal System at: 1402..... ..._.......-•••---------••.......... ...••...........-• .................._. Localimi-Address or Lot No. .................! o.t ton.-/?e�iQ Fh_ �_ -•-------•----------•------................................--•---.........................._...-- owner Address W7.P. (7ac,o %2.:zit....--•--...-----•.................•- ----....................................-- ............................ ..................... a .... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.....3....................................Expansion Attic ( ) Garbage Grinder (N/9) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ------------------------------- - - W Design Flow................................:...........gallons per person per day. Total daily flow.........................,::................gallons. WSeptic Tank—Liquid capacity............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 by.......................................................................... Date........................................ 1-1 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -----------------•-----.......................................-••••---•......•-•.....---------_...--......................................................... 0 Description of Soil........................................................................................................................................................................ W ......... �L5 J-----------•---------•------•------•--•--•-•................... x U Nature of Repairs or Alterations—Answe when applicabl . . f.t...Co:,y-,c�fl�,�„-••-.�,��, c $� Eyf: �•S�jI�••- gc:_ .lon..._ ��.��s.._1.--cl �.t-.2,:a x. 30__,?.z:::%t.u:_t•7- h...!'l;a '_C�... n...zwn._..... Agreement: �.ee..`. .�° �st.o^e, 26 . 5L 9 'ld, )_4" undelt The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sid .. .-. .-/! / ......�/........................ .....9./!4.l ..�..., ...-... ApplicationApproved By ............................ .... .. .........../- .........: ....-..................................-......-...................... ....... ..g�... S Application Disapproved for the following reasons: ........................................................................................................................................ ... ....................... ... ... . Q �f Permit No. ! ) : /...... Issued ......................�....�1..................�rc...... ....................... ...................... .... ......... ........../... .. Da e i -------------------------_—---•— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE %Lxr#ifirak of (gompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedXXXX) 7. �'. 17QC0fl2�iP.2 a•Z. b ....:.-.-. 1102 Chip i 12.ive2...Road...'^.ent_e�ci����e............ .......................................................................................... at ...._............_........................ ......._...... has been installed in accordance with the provisions of TITLE 5 of The State nvironmental C as rriibed in the application for Disposal Works Construction Permit I �4 S.—...�.. � ........ dated ...- ...7-..l,�S ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT SE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIS,;� CTQRY. _. DATE..-_. .._....... ..... . .....-.....� .................._....--.... Inspectd.. �'.-...� .................-............... G THE COMMONWEALTH OF MASSACHUSETTS s, BOARD OF HEALTH TOWN OF BARNSTABLE Dinpnout Works Tnnntrudian ramit Permission is hereby granted.4-•-P.Aa c-oml p-,t... .----•--- --••--------------------------•---------.......-------•-------•--............-----•... to Construct, l ) _or RepaiT,:�.X an Individual Sewage Disposal System I;t1M126 lt.!„e.R. Road' C P_lLte2vG�Fw / ....... at No........................................................................................................................................... ------------------------------- -----•-•---•-•••--•----•-----•- .----- -----•--•---•-•-- -••••--- Strcet n as shown on the application for Disposal Works Construction-Permit No,9�_/,/Vaitd.._._...�Vt�l.....�....... DATE...................1l /,: ............................... FORM 36508 HOBBS 3 WARREN.INC..PUBLISHERS TOWN OF BARNSTAB_LE LOCATION / 0�2- Ku Y SEWAGE VILLAGE �`t-E'-�' ASSESSOR'S MAP 6r LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BT1IT_DRP. OR ()VINER DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: ., _ ���� ,�" D �� � t �, °� ti, „ '� t00 Igo:: - Fss. t� THE COMMONWEALTH OF-MASSACHUSETTS 71y BOAR® OF HEALTH TOWN OF BARNSTABLE AVV iration for Dio.Vooul Work,6 Ton itrnrtion ranfit Application is hereby made for a Permit to Construct ( ) or Repair (x)) an Individual Sewage Disposal System at: ..................-......-..............I....--------•--....----•--•-----•------.................. -------••---------•-----•-----•••---......•---------•----•------•-----..............••--••..------ Location—Address or Lot No. 1 ..................---._..--•--..............................-----.................................. --•-•---------------.....-----------------....._.................................................. p Owner Address Installer Address UgType of Buildin Size Lot............................Sq. feet ►. Dwelling 1- No. of Bedrooms-----3...................................Expansion Attic ( ) Garbage Grinder (N;)) aOther—Type of Building ---------------------------- No. of persons---------3_---------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow..----...._-------..__...;.'_-.-......------gallons. h W Septic Tank—Liquid capacity...._-._._.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 by---------------------------------------------------- --------------------- Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.................._..... f14 Test Pit No. 2................minutes per inch Depth of Test Pit._............_---_. Depth to ground water........................ P4 -•--•------------------------------•---------...-•-•------•.....-•-•--•----•---••------.........----......................................................... 0 Description of Soil......................................................................................................................................................................... .- .J •- =------•-•------------------------ ---- V Nature of Repairs or Alterations—Answe when applicabl . . Ll ...o I_5Ijt1------- ion-- 'c.� 9 r1 �.t_.z % ��>.x.: .-_'�_...3a U--'?- ��.�t:_ ;• =' ' �t'.. !�...z'..n.... .. .�.. Agreement. o:! ?_ . 5L 9 'GI, 24” un.ln,z The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Application.Approved By ------ -------`--.. /-/ to �� Date Application.Disapproved for the following reasons- -------------_----------------------._------------------------............------------....-.......-----.--------------------- -------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------- Date Permit No. - V---- Issued -------------- k FEs.............................. j THE COMMONWEALTH OF`MASSACHUSETTS ' /y )I BOARD OF HEAh-TH. TOWN OF BARNSTABLE ,� lirtttila,t fnr Diti-putial Wnrkii Tomitrnrtiun erntit Application is hereby made for a Permit to Construct ( ) or Repair (X,y an Individual Sewage Disposal System at: 1402 Bumlm Riven Road Cen�envie�e .....................••--............_..---------•-••------•--••---•-----••-------------------••. •-------•-----•--------••--•-••---------•---•--•------------..........-•-•----•---•-----•-----•-- Location-Address or Lot No. Cotton- RgaZ £.s.tate ---•••--•----•----•----•-•--- --•-----••--•--•--••---••••-•--•--••--.......-•-•••-•----••-••----•----------------------------••. Owner Address W /.....(7acom.�e2 ��. ►a ................. ..,..... -------------------••------•••----•- -•-••-----•----------.....-•••---•----------•••-•---••--------•-•••---••••----.....----......... Installer Address :U Type of Building 3 Size Lot............................Sq. feet Dwelling 7 No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (NO) 44 Other—Type of Building ---------------------------- No. of persons--.-.._..3---_------------ Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow_:---------------------------------------gallons per person per day. Total daily flow-------------------------------------.......gallons. o: Septic Tank—Liquid capacitv............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 ( ) `-� Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 14 Test Pit No. 2................minutes per inch Depth of Test Pit...---------.-.---_ Depth to ground water....--.-------..--.-.-. C� --------------------------------------------------------------------------------------------••----- Descriptionof Soil------------------------------------------------------------------------------------------------------------------------ v ................. and.--`�--- zavg • •••----------------------------------•-•------:-------- ----- / z U Nature of Repairs or Alterations Answer when applicable._.-r ��--..CZ.-34.t; 11 rn..6 nn---A-0x�.'. D 30 /2 hc� get -. ackgd n...two.. Agreement: tee-it of .6tone. 26. 5L 9'41 Tit"t� undea .inve'ti. + The undersigned agrees to install the afaredes Abed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State,Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of (!2mpliance has been issued by the board of health- r .,+e Sl d .:..- -- Y---� _..: ,. -�.....� ...................... .....914195. . .......:..---- Application,Approved By ........... - ��% r X _..... Dace Application.Disapprovve;d for the following reasons: ---------- ---------------------------------------------------------------------------------------------------------------- ................................ ............. .. ........ ------------ -- --------__------------- --------------------------------------- ---- 1 1 n _Date Permit No. ....------------------ . - Issued �.....j. THE COMMONWEALTH OF MASSACHUSETTS \ BOARD OF HEALTH TOWN OF BARNSTABLE Ilertifiratic of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or RepairedJ(XXX) by .P.l7acom.&e2 ;,%. -.... ......................................------......------.._._....----------------------------- Iasr.Jlcr at ................1.402 Pumpz Rive4 Road---------Cente�vi2�e -------------------- ---- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. _�� :.. .. �'z/............ dated .--. 7 _.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �} 1 DATE.-- ^ ' '...------ , ----------------------- Inspecto'>:• 9 � 6AW . -------------- ------------------------ _--------- ---- - - ------ THE COMMONWEALTH OF MASSACHUSETTS — BOARD OF HEALTH ` TOWN OF BARNSTABLE No....... J FEE...5...30 e.Oa- �t��rnsttl nrk� �nn.�trnrtilan �rrntit Permission is hereby granted. -.-P,-,60.r n m R. -...1-4.----------"--------------------------------------------------"---------....-----........-•-•--. to Construct ( ) or Repair i(XA) an Individual Sewage Disposal System at No.•--•••.....62---�ump� /Z.�vez Road Cen e2v t o Valt -... --•--------------"---•------•-- --. Street - /� V 1as shown on the application for Disposal ���orks Construction PermitNo. .:................./ d.. c �iealth^-'1-•-••-----•--••-------------------- DATE ��. ,--....--•-••......--•---...... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 916 h n Ec �Q.4 v �� ! ' /ate o 0 c . CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) Crt, , hereby certify that the application for disposal works construction permit signed by me dated �— , concerning the property located at wo meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICE SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. COMMONWEALTH OF MAS.SACHUSETTS Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.211 S 197, 454 CMR 22.00 and 105 CHR 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor performing project Atlantic Home Deleading & cnnstriidicenge # oni-mr, Exp.datq()/96 Lead Paint Inspector Fred Hemmilla License # M2736 Date of Inspection 7/12/95 If low-ri-sk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Floor Street Address -14Q2-B1=s-Ri_<ver-Roa(J Apt. No. City centerville.,_ Ma. Zip Deleading MethQWet/Dry Scraping Heat Gun _-" Caustics Liquid Encapsulant Covering- Demolition Replacement Other If "Other" selected, please explain "------ Check One: dwelling is multi-family single family X Start date March 20, 1996 Completion date April 10, 1996 When will work be done: A.M. X P.M. X Weekends? Project Supervisor's name Raymond J. Benson License # 001025 Property Owner John Wood Address 1402 Bumps River Raod -- City Centerville, State Ma. Zip Telephone 563-5030 f In case of emergency contact Atlantic Home Deleading & Consruction Co., Inc. Phone: day 830-9383 evening 830-9383 (over) 1 i i I In accordance with Massachusetts General Laws c. ill § 197 CMR 22.00 and 105 CMR 460.000 notice' of the date and methods(s) of removal or covering of paint, plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received by the following. persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-8436 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Fax (617) 727-7568 Department of Labor 6 Industries Room 11006, 100 Cambridge Street Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive delead61gFax ) 727-5128 Deleading Contractor The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. Date 3/11/96 Signed: Title: pry' Company: Atlatnic Home Deleading — Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations, 105 CMR 460.175, for owner/agent low-risk abatement and containment. I further certify that I or my agent will be performing the following low-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying axterioi vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge- anal heli?f. Date: ------ ----------- Signed: — -- REV 10/12/95 Sr:wAh�; 1NSYr;C'1'TUN OCATI(JN t 2 �YYI '— t er DATE � ` I04 LAGL? 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