HomeMy WebLinkAbout0116 CAMP OPECHEE ROAD - Health 116 Camp Opechee Road, Centerville
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UPC 13534
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Town of Barnstable Health Inspector
�tNE Office Hours
do Regulatory Services 8:00—9:30
Thomas F.Geiler,Director 1:00—2:00
BAMSTABL& Only
,"� ,0� Public Health Division
Leos Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information: _
Address: /l¢ C&rnin 0Qe- I et leead Map Parcel /o/37-003
Ceh-tervi//e, mq
Name: —J-6hn f Llnnecu "en rnessU Phone: C l-7-59 3 — 9 0 6 a--
2. How many bedrooms exist on your property now? 4 —
2a. Please include a copy of your floor plans for the entire property.
3. Is the dwelling connected to public sewer? YES or
If the dwelling is connected to public sewer, skip questions 4-9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public
supply wells? _
5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO
6a.If yes,how many bedrooms were approved according to this permit? Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
o. Is there an engineered septic system plan on file at the Health Division? YES or NO ��'n
4:ty:)D6-nj
9. Has the septic system een inspected by a DEP certified inspector within the last two years?
YES or NO �s�a
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FOR OFFICE USE ONLY K
TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY
_�.-,k,�• I e� ma`s b`"�k�.��
The Public Health Division has no bjection to bedrooms at this property.
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Signed: Date: L140
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Inspector(Print): 1,h0 me< A. Me 4,XA, CHO .
Q:PT/AMNESTY/PUBLCHLTH.doc
McKean, Thomas
From: McKean, Thomas
Sent: Thursday, September 04, 2003 2:25 PM
To: Mcauliffe, Paulette
Subject: 116 Camp Opechee/ New Application under the Amnesty Program/A=210-139-003
Hi Paulette,
I have no objections to four bedrooms at the above referenced property.
However, there are a few outstanding issues:
1) The septic system was inspected in 1997 by J.P. Macomber. He discovered that a tee was broken at the tank invert.
Also, the pipe entering the invert had the PITCH going the wrong way. I asked the homeowner about this. He indicated
that he thought it may have been straightened-out before he purchased the property. I looked in our records and in the
computer database; but I did not see any permits for any repair work to the system. The homeowner recalls seeing a form
at the closing when he bought the property. However he is not sure whether the piping and tee were corrected. I
suggested that he call Macomber to see if he has any records of a repair there. If any records are found, I asked him to
have them forwarded to this Office.
2)The submitted floor plan did not match the submitted building sketch. The building sketch shows two bedrooms plus a
den on the second floor of the main house. However, the submitted floor plan shows only two bedrooms on the second
floor on the main house. One of the bedrooms has two doorways. According to Mr. Hennessey, the wall between the den
and the bedroom was removed. We will need some assurance that the wall was in fact removed and will remain removed-
otherwise, this would be bonsidered a five bedroom dwelling triggering a Title 5 inspection and possible
upgrade/replacement of the system.
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
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DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTfMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEPART ACERTIFI ATION
�t7E�MA
Property Address: 116 CAMP OPECHEE RD BAR 02630
Owner's Name: ALBERT MARINO -'
Owner's Address: 135 CASTLE HILL AV GREAT BARRINGTON MA.01230 C"cA-3
Date of Inspection: 2/1/01
Name of Inspector: (please print)', JOHN GRACI RECEIVEDi
Company Name: `'SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 F E g 16 2001
Telephone Number: 508-564-6813 FAX 508-564-7270
TOWN OF BARNST'ABLE
HEALTH DEPT. - }
CERTIFICATION STATEMENT
f,-
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(310 CMR 15.000). The system:
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X Passes "
_ Conditionally Passes
_ Needs Furt a valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 2/1/01
The system inspector shall subm' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspection. If the system is a shared system or has a design now of 10,000 gpd or greater,the
inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be ;.
sent to the system owner and copie's,sent to.the buyer, if applicable,and the approving authority.
Notes and Comments .'i:'�
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO _'[ >
PROLONG THE SYSTEM'S USEFULL LIFE. 5%"
****This report only describes,,conditions at the time of inspection and under the conditions of use at that time.This '.r
inspection does not address how the system will perform in the future under the same or different conditions of use.
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Title 5 lncnartinn Fnrm 6/1 ri00 0 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
Inspection Summary: Check AB,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.
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Comments:
THE SYSTEM PASSES TITLE V 1NPECTION.RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO `
PROLONG THE SYSTEMS USEFULL LIFE.
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 t
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
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Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
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
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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 deferrnine dist4nce n/a
"This system passes if the well water':analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicatcs1hat 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:
n/a
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Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections: # F
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 ''/z day flow
- X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times ',i_`- .
pumped n&. p
- X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X An onion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
- Y P P P �Y PP Y rY
- X Any portion of a cesspool or privy is within a Zone I 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.]
(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.
is
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) 5
yes no
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- X the system is within 400 feet of a surface drinking water supply
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- X the system is within 200 feet of a:tributary to a surface drinking water supply
- X the system is located in a nitrogeh 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.
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Page 5 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO ,',,,,
Date of Inspection: 2/1/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
f
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?
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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 examp!e,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)[3 10 CMR 15.302(3)(b)]
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Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630 `!
Owner: ALBERT MARINO '
Date of Inspection: 2/1/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
i.
Number of current residents: 0
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): YES
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL '
Type of establishment: n/a
Design flow(based on 310 CMKk,15.203): n/agpd
Basis of design flow(seats/persons/sqft,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
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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 `a }
X Septic tank,distribution box,soii,absorption system . �
_Single cesspool t
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any) t.
_Innovative/Alternative technology. Attach a copy of the current operation and rnaintenance 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:
1991
Were sewage odors detected when arriving at the site(yes or no): NO
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Page 7 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01 '
BUILDING SEWER(locate on site plan) '
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Depth below grade:30" :R
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: 24"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a i
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: 1000G L 8' 6" H 5' 7" W 4t 10,1111
Sludge depth:3"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness:8"
Distance from top of scum to tpp of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 0"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING {
NOW AND EVERY TWO YEARS'TO PROLONG THE SYSTEM'S USEFULL LIF
i
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 N>.
Comments(on pumping recommendation's,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related i
to outlet invert,evidence of leakage,etc.):
n/a
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Page 8 of 11
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
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
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:_(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
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.):
n/a
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
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Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
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Page 9 of 11
OFFICIAL INSPECTI®NTORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/l/01
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation net required)
If SAS not located explain why:
n/a
Type i
1000 GAL 6' X 6' leaching pits, number: 1
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: nla
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.):
THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT
WAS EMPTY AT THE TIME OF THE INSPECTION.THE PIT HAS NOT HAD MORE THAN 2' OF WATER IN
IT.
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
'7
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
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Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
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.
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Page 11 of 1 I
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OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 116 CAMP OPECHEE RD BARNSTABLE,MA 02630
Owner: ALBERT MARINO
Date of Inspection: 2/1/01
SITE EXAM '
_Slope s
t
_Surface water i
_Check cellar
Shallow wells +
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
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NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators;3installers-(attach documentation) ;
YES Accessed USGS database-explain'; n/a
;T
You must describe how you established the high ground water elevation:
USGS MAPS AND CHARTS.- 12+FEET
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• Y
DATE : 11 /24/97
PROPERTY ADDRESS: 'Michael Sokolowski
116 Camp Opechee Road
Centerville,Mass. 02632 1
On the above date, I Inspected the septic system at the -above addre8e.
This system consists of the following:
1 . 1 -1000 gallon septic tank.
2 . 1 -Distribution box.
3 . 2-1000 gallon precast leaching pits.
Based on my Intkv�ectlon, I certify the following conditions:
4 . This is a title five septic system.'" ( 78 Code )
5 . The septic system is in proper working order
. at the present time.
6 . Tee is broken at tank invert. Pipe is entering invert of the
tank with a PITCH going the wrong way. Piping should be corrected.
7 . One leaching pit is 40" below grade. The .cover should
be raised.
SIGNATURE:
Name : J . P . Macomber Jr•.
-------,---------------
Company:_�• P`Macomber &— Son'_Inc ..
Address :--5eac—bb-------I—_----
__Centervi 1 Le LMass__02632
Phona : 508.37.5 338______- I
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
L1. P, MAC�OMBER & SON, INC.
7�nkrCeupoolrl.eschfleld�
Pump+d L Inst,411 d
Town Sewer Connections
x 66 ' Centerville, MA 02632-0066
775 33U 775- 412
COMMONWEALTH OF N ASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTIO-,
ly
ONE WINTER STREET. BOSTON, N1A 02108 617-29' �SOG
1� 121
T,.
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Goy cmor 1
ARGEO PAt1L CELLLCCI �O/' D,.\
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Li Gov cmor SUBSURFACE SEWAGE DISPOSAL SYSTEM IN � ION F6R
PART A O —
CERTIFICATION �' �,19 W
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Property Address: 1 1 6 Camp Opechee Road CenterviAUass of r:
Date of Inspection:1 1 /24/97 (If different) -e 44
Name of Inspector: .TctsPp h P_Maramber Jr.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 C =A?
Company Name: J.P.Macomber & son Inc.
Mailing Address: BOX 66 Centerville ,Mass , 02632
Telephone Number: 5()8— 75_3238
CERTIFICATION STATEMENT
I cen,fy that I have personally inspected the sewage disposal system at this address and that the information reponec Selo- s u..r
and complete as of the time of inspection. The inspection was performed based on my training and experience in the prop-er i n,.on. ar
maintenance of on-site sewage disposal systems. The system:
.t
asses
Conditionally Passes
Needs Funher Evaluation By the Local Approving Authority
Fails
Inspector's Signature: yar/ Date: 7�
The System Inspect all submit a copy of this inspection report to the Approving Authority within thirty (30) says of compe;in - .
,nspect,on If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system o-T,.ef snag s_o^
the report to the appropriate regional office of the Depanment of Environmental Protection The original shoule ce sen: :o ;re
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A B C or D.
AI SYSTEM PASSES:
_Zi have not found any information which indicates that the system violates any of the failure criteria a5 dei,nzd 3.0 C." ; 3.
Any failure criteria not evaluated are indicated below.
COMMENTS:
81 SYSTEM CONDITIONALLY PASSES:
,&0 One or more system components as described in the "Conditional Pass" section need to be replaced or repaired The sss:e---
completlon of the replacement or repair, as approved by the Board of Health, will pass.
Ind,ute yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined-,
y The septic tank Is metal, unless the owner or operator has provided the system inspector with a cop,. of a Cen a:r
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the Bate cf !--e s r cr
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial rnfillraljon or ex7wra:ip^ �• ;;
failure is imminent. The. system will pass inspection if the existing septic tank is replaced with a conform,ng
as approved by the Board of Health.
' (r.�i..d 04/25/9!1) P49. 1 of 10
DEP on the Wono Wide WeD nnp rrwww magnet state ma uvoep
in Pnnteo on Recycieo Paper
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Ptoperty Address: 116 Camp Opechee Road Centerville,Mass.
O»ner: Michael Sokolowski
Dale of Inspection: 1 1 /24/97
e) SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to oro,en o
pipets) or due to a broken, senled or uneven distribulion box. The system will pass inspect,on I
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
( The system required pumping more than four times a year due to broken or obstructed p pets) Tne sys!e,
nspeci,on f (with approval of the Board of Health)
broken pipets) are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
k1i) _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system .s is W)z .o xo:e(7 "e
puol,c nealth. safety and the environment
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUN'CTIONIwC In A
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
�t Cesspool or privy is within 50 feet of a surface water
tip- 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 APPROPRIATE) DIFTE
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a s.;n,ce
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water spat wets
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water -e!
( The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet of more :t —
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compo---s - _a:e, : •�
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate -itoge-
less inan S ppm method used to determine distance 40 (approximation not valid)
3) OTHER
tr.v1 .0 0�/21/f�) D�q• 2 of 10
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR"
PART A
CERTIFICATION (continued)
Property Address: 1 1 6 Camp Opechee Road eENTERVILLE,Mass .
o..ner: Michael Sokolowski
Date of Inspection11 /24/97
D) SYSTEM FAILS:
You must indicate e�. el --Yes' or "No' as to each of the following
i have determined that the system violates one or more of the following failure crilena as def,nec 310 C
for this determination is identified below. The Board of Health should be contacted to determine what welt ,>e necn,;r ,
the failure
Yes N
1/ Backup of sewage into (aciliry or system component due to an overloaded or cogged SAS Or cessooc'
Y Discharge or ponding of effluent to the surface of the ground or surface waters due to an o:enoaeec c �3r=
cesspool
Static liquid level in the distribution box�ove outlet inven due to an overloaded or c!oggec SA•S c
Liquid depth in ;@iliPQ I is less than 6" below inven or available volume is less than 1,'2 day
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets,
Number of times pumpedGky
Any ponton of the Soil Absorption System, cesspool or privy is below the high groundwa!er
Any ponion Of a Cesspool or privy is within 100 feet of a surface water supply or tnbutar; :o a
Any ponion of a cesspool or privy is within a Zone I of a public well.
ponion of a cesspool or privy is within 50 feet of a private water supply well.
��Any
� Any ponion of a cesspool or privy is less than 100 feet but greater than 50 feet from a pt,�a:e wavers _: -e
acceptable water quality analysis If the well has been analyzed to be acceptable, anach coos of ell :e
col,form bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen
E( URGE SYSTEM FAILS:
tov must indicate either "Yes' or '*No'* as to each of the following
The following cntena apply to large systems in addition to the criteria above
y1C) The system serves a facilrry with a design flow of 10,000 gpd or greater (Large System) and the sys!e•rn s a s.gn•
public health and safety and the environment because one or more of the following conditions exist
Yes No
10 the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
N� the system is foaled in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the ground a;e< :rea!—e-- = _;
rewuiremenrs of 314 CMR 5.00 and 6 00 Please consult the local regional office of the Depanment for funner n:or•T.a:,c-
tr.�i..0 0./75/971 P.g. 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1 1 6 Camp Opechee Road Centerville,Mass .
Owner: Michael Sokolowski
Date of Inspection: 1 1 /24/97
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following
Yes N
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least rwo weeks and the system has been receiving normal
now rates during that period. Large volumes of water have not been introduced into the system rece—,
as pan of this inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A
The faclliry or dwelling was inspected for signs of sewage back-up.
The system does not receive non sanitary or industrial waste flow
_ The site was inspected for signs of breakout.
_ All system components. i-ieluding the Soil Absorption System, have been located on the s,te
The septic tank manholes were uncovered, opened, and the interior of the septic tank was rnspeezed for condition o
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum
— The size and location of the Soil Absorption System on the site has been determined based on.
The faciliry owner (and occupants, if different from owner) were provided with information on me proper na ;e^.ante
Sub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of d,stance 's
unacceptable) )1 S.302(3)(b))
P.g. 4 of 10
I-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 116 Camp Opechee Road Centerville,Mass .
Owner: Michael Sokolowski
Date of Inspection:) 1 /24/97
FLOW CONDITIONS
RESIDENTIAL:
Design now p d,/bedroom for S.A.S.
Number of bedrooms: _ _
Number of current rend nts:•a v�C�NT
Garbage grinder (yes or no):—V-0
Laundry connected to system (yes or no): le,
Seasonal use (yes or no) /Vu
water meter readings, if available (last two (2) year usage (gpd): ` •� Z6,J A'6� X '
Sump Pump (yes or no):220 !��— /dc�d 9414'4J.,5r_/7S' `/ c�j. � 6
Last date of occvpanc) cvr,%,\/ 11P
COMMERCIAUINDUSTRIAL:
Type of establishment. AM-
Design tlow:_A2A gallons/day
Grease trap present. (yes or no).,Q—fi
industrial Waste Holding Tank present: (yes or no)-&,4
1on-sanrtary waste discharged to the Title S system. (yes or no) AJ/f
V,'ater meter readings, if available 464
0 Last date of occupancy 109
OTHER: (Describe)
Last date of occupancy
GENERAL INFORMATION
PUMPING RECORDS and sou r/ce of information:
��lfiP
System pumped as pan of inspection: (yes or no)A,--b
If yes, volume pumped �/U� gallons
Reason for pumping /UK
TYPE 0 Y S T E M
Septic tank/distribution box/soil absorption system
yu Single cesspool
AA) Overflow cesspool
/-10 Privy
� Shared system (yes or no) (if yes, attach previous inspection records, if any)
rr? I/A Technology etc. Copy of up to date contraaf
Other A)
APP ROXIKATf AGE of all components, date installed (if known) and source of information:
'' ;�' .&I/y# qe 32�Y �r air �k �4�-�/l6 ---jet
U6�6'
Sewage odors detected when arriving at the site: (yes or no) 4-cJ
Ir•vi••d 0�/75/97) ➢.q. 5 of 10
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^ t 11
E
DATA
TOWN OF BARNSTABLE
ATION SRWAGE # -
\ LAGE CeA l;;r U,Ile' ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO. h)/tpleeS C hC CC SyD" 77Fl
SEPTIC TANK CAPACITY
.10 LEACHING FACILITY:(type) (o.f' (D . P / (size) (SOQ
NO. OF BEDROOMS ��... PRIVATE WELL OR PUBLIC WATERt1;C
BUILDER OR OWNER kl-M hi r 9O/l)
DATE PERMIT ISSUEDr
DATE .COUPLIANCE ISSUED
VARIANCE GRANTED: Yes No
D-�1 .
flax I S
tic
t -
TOWN OF BARNSTABLE
LOC TION SEWAGE #
VILLAGEn ASSESSOR'S MAP &'LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
MOO u
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: T
VARIANCE GRANTED: Yes No-
H
�S g 3z
• Ya
ILI
. .. �o
ti 7 �• � '�4
4
-0
i
SUBSURFACE SEWACE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 116 Camp Opechee Road Centerville,Mass .
owner: MIchael Sokolowski
Date of Inspec"onl 1 /24/97
EIUIEDIN'C SEWER:
,rotate on site plan)
'r
Depth Belo, grade
Material of conslruclion ✓Cas( iron Z4"0 PVC _ other (explain)
Distance from,privale water supply well or suction line
,/
Diameter
Comments (condition of joints, venting, evidence of leakage. etc )
el 744&A'11
AZZ-1s -'.,12 J�
SEPTIC TANK
,oc.a:e on we plan'
Depth below grade
mafer.al of construcl,on: oncrele _metal _Fiberglass _Polyethylene _other(explain)
I: ;ans, is metal. list Is age confirmed by Cenificale of Compliance 414(Yes/No)
D'mens.ons
Sluoge depin. ei
Distance from top of sludge to bonom of outlet tee or baffle: 3l
SCvm thickness y 4
D,stance from top of scum to top of outlet tee or baffle: ��
D,stance from bonom of scum to bonom of outlet tee or baffle I
"ow d,mens,ons were determined
C om.'nen!s
,recommendal,on for pumping, conditio of inlet and outlet tees or baffles, depth of liquid level in relation to ouuel Inver.
ntegrih. evidence of leakage, etc ) 4 rt e
r 'r Ti
CREASE TRAP:�s�
:joule ors site plan)
Dep(n below grade A—)A
tisater,al of con struclron:,iL4—concreteCltmetaIZ/*iberglassV?V Polyethylene other(expla n)
D,mens,ons: A/!4
Scum 1h1<kness._.4A
Distance from top of scum to top of outlet tee or baffler
D,stance from bonom of scum to bosom of outlet tee or baffle: ti),f
Dale of last pumping —2/
Comments
trecommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet Inver.
nfegnry, evidence of leakage, etc 1
cv
rr.vt••C 0•/]D/971 P•q• 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 116 Camp Opechee Road Centerville,Mass.
Owner: Michael Sokolowski
Dale of Inspection: 11 /24/97
TIGHT OR HOLDING TANK: Tank must be pumped pn(,r to, or at time, of inspection)
(locate on site plan)
Depth below grade
Material of consuva on.) concreteXWmetaW Fiberglass�>�Polyethylene�I�other(explain)
Dimensions: 4
Capacity: A/� gallons
Design flow. "_ gallons/day
Alarm level'_ � Alarm in working order// Yes:,jA No
Date of previous pumping
Commems
(condu.on of inlet tee, condition of alarm and float switches, etc 1
DISTRIBUTION BOX:-/
locate on site plan)
Depth o: hcu,d level above outlet inven:-
Comments
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc )
PUNAP CHANABER:_,dfrti/e_
iloute on sne plan)
Pumps r, .,-or'K,ng order: (Yes or No)-,�V—*
Alarms �n working Order (Yes or No)—d�
Comments
(note condition of pump chamber, condition of pumps and appunenances, etc.)
lr•v:..G 04/79/97) ➢•g• 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Address: 1 1 6 Camp Opechee Road Centerville,Mass .
Owner: Michael Sokolowski
Date of Inspection: 1 1 /24/97
SOIL ABSORPTION SYSTEM (SAS).C-jaV� '� '� 4 "`�'V
;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, number:
leaching chambers, number.
leaching galleries, number
leaching.trenches, number,length,
leaching fields, number, dim�sions:
97
overflow cesspool, number:_
Alternative system: 'V+ i Name of Technology: e, Z Zir;, .
Comments
(note condition of soil, s1 ns of hydraulic failure, level of pondin�, condition gf vegetation, etc.)
J GA �/
r f
7- Lklqe-
CESSPOOLS:
(locate on site plan)
Number and configuration: IVA r
Depth-top of liquid to inlet tnverl:
Depth of solids layer:
Depth of scum layer: .UA
Dimensions of cesspool. 44/
Materials of construction:
indication of groundwater: 41
inflow (cesspool must be pumped as pan of inspection)
Comments.
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PR IVY:
��
(locate on site plan)
Materials of construction: Al/o Dimensions:
Depth of sohds:—AA�—
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
E' /v' A2 nay?" 1:&' /?'
(r.vl..d 04/25/97) D.9. 8 of 10
U
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Address: 116 Camp Opechee Road Centerville,Mass .
Owner: Michael Sokolowski
Date of Inspection:1 1 /2 4/9 7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
—Ae t-es to at least two permanent references landmarks or benchmarks
locate all wells within 100 (Locale where public water supply comes into house)
rd% 1'—Q
�Y
(1.•1..: 11/25/97) P.y. 9 of 10
SUBSURFACE SEWAGE DISP SYSTEM INSPECTION FORM
SYSTEM INFO(: ION (continued)
Properly address: 1 1 6 Camp Opechee Road Centerville,Mass .
owner: Michael Sokolowski
Dale of Inspection:11 /24/97
/1
Depth to Groundwater _7 Feet
Please indicate all the methods used to determine High CroundwaW EIL, ation:
a/Ob:a,ned from Design Plans on record
�Observal,on of Site (Abuning property, observation hole• basemcr*s,mp etc.)
4ZDetermine it from local conditions
neck -,In local Board of health
/Check FEmA Maps
�/ Check pumping records
neck local ercayators. installers
use 'USCS Data
Desc,oe n your own words how you established the High Crouncyws+ef E Ievat.on. Must be completed) -
House is high on the top of a knoll.
Used Cape Cod
Water Table Contours
And
Public Water Supply
Wellhead Protection Arena
September 1995
Water Resources Office
Cape Cod Commission
Map.
Ir••S r.G 0�/7 s/971 Y.q• vl 10
. r.T.nr•r^nrr-rr ir+r. mr nrn rs�n.rnr.rr..r...�+-r:tmr.�rrsrm-.nr.'ti-at*rar.rsr:rrn
TOWN OF Barnstable BOARD OF HEALTH
I S0I3Sll1iFACF SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D .- CERTIFICATION
`� �•.•T••• T".-'.'e�T.IIT^.�.T.T.�1'R:1T�T�.T.TTTSTTT'T•.'1"'1'T�'7 TRTJr�-rl"..T.ATi1'R"'�'L�TIGT7
mnnTnrrnT.ry:Trrrr•.+r.:—rrrr•�. —.
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 116 Camp Opechee Road Centerville,Mass
ASSESSORS MAP , BLOCK AND PARCEL # 210-139-003
OWNER' s NAME Michael Sokolowski
PART D - CERTIFICATION i
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber, & SorP'tnc.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street Town or City Stat• iIP
COMPANY TELEPHONE (508 1 775 - 3338 FAX ( 508 ) 790-1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal 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-
site sewage disposal systems .
Check one :
G//;/S ys teui PASSED
The inspection «hich I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or Lhe environment as defined in 310 CMR 15 . 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have condaucted 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 Signature /,U Date 11 /24/97
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the DOARD OF HEAL11I.
* If the inspection FAILED, the owner or " _Perator shall upgrade the aystem
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 310 ChJR 15 . 305 .
Partd . doc
I
ti
Sb-N -�y7l
THE COMMONWEALTH OF MA.SSACH USETTS
DEPA.RTNZENT OF ENVTRONNEENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CER { D TITLE S SYSTEM ]INSPECTOR
as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the
General Laws . Issued by Talc Department of Environmental Protection.
J u nc 8, I S — ----__.. ---- — —
Acting Dircclor of the O� z". t-)( W2Icl Pollu['lOn Control
, 1
1� l
1
Barnstable Assessing Search Results Page 1 of 2
r
t
y
Home: Departments:Assessors Division: Property Assessment Search Results
......... i .................................... w9w..
99
116 CAMP OPECHEE ROAD
2003 Owner Information:
Owner Name Property E ketch Legend
HENNESSY,JOHN C&LINNEA M
Map/Parcel/Parcel Extension %
210 /139/003
Mailing Address
HENNESSY,JOHN C&LINNEA M
823 CENTRAL ST
HOLLISTON, MA.01746
2004 Owner Information (as of January 1, 2003)
Owner Name
HENNESSY,JOHN C&LINNEA M
Address
116 CAMP OPECHEE ROAD
2004 Total Assessed Value
$396,800
2003 Assessed Values:
Appraised Value Assessed Value
Building Value: $ 157,600 $ 157,600
Extra Features: $2,800 $2,800
Outbuildings: $0 $0
Land Value: $67,800 $67,800 Interactive Property Map: ap requires Plug in:
iw
Totals:$228,200 $228,200 1 have visited the maps before
Show Me The Map +
April 2001 photos available `
Sales History:
Owner: Sale Date Book/Page: Sale Price:
HENNESSY,JOHN C&LINNEA M 3/5/2001 13615/086 $255,000
MARINO,ALFRED& BOBER, KIM E 12/5/1997 11101/232 $0
SOKOLOWSKI,JONA&RUTH& MICHAEL 10/15/1989 6934/326 $63,000
MASS, EDA 10/15/1989 6906/123 $63,000
WANNIE,T WALTER&MEREDITH 12/15/1987 6073/096 $ 1
2003 Tax Information: Tax Rates: (per$1;000 of valuation)
Town Tax $2,145.08 Town Fire District Rates Other Rates
9.40 Barnstable 2.88 Land Bank 3%of Town Tax
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 9/2/2003
Barnstable Assessing Search Results Page 2 of 2
C.O.M.M. FD Tax $351.43 C.O.M.M. 1.54
Cotuit 1.88
Land Bank Tax $64.35 Hyannis 2.89
West Barnstable 1.96
Total: $2,560.86 Due to rounding differences these values may vary
Land and Building Information
Land Building
Lot Size(Acres) 1.17 Year Built 1989
Appraised Value $67,800 Living Area 2298
Assessed Value $67,800 Replacement Cost$ 171,336
Depreciation 8
Building Value 157,600
Construction Details
Style Cape Cod Interior Floors Carpet
Model Residential Interior Walls Drywall
Grade Average Grade Heat Fuel Gas
Stories 1 1/2 Stories Heat Type Hot Water
Exterior Walls Wood ShingleClapboard AC Type None
Roof Structure Gable/Hip Bedrooms 4 Bedrooms
Roof Cover Asph/F GIs/Cmp Bathrooms 3 Bathrooms
Total Rooms 9 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL2 Fireplace 1 $2,800 $2,800
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 9/2/2003
i
% BUILDING SKETCH
/ Borrower:Hennessy,John C. File No.: 74533621
Property Address: 116 Camp Opechee Road Case No.:Ln#4915500
City:Centerville State:MA Zip:02632
Lender:Merrill Lynch
22.0'
12.0' Deth 2634 Si 12.0'
20.0'
Laundry 8.0' 24.0' 8.0'
Kitchen 14.0'
24.0' up Dk 8ttsi
Family Room
12_0' 168 OP
First Fk9W FU1 Bsmt
1,312 st
Liringtoom up Two Car
Bedroom 14.0' 576 sf 14.0'
s1
t0.0'
32.0'
FfiQMT 24.0'
Bath Den nova
Bath Kitchen
22.0' Bedroom �t> __ do 20.0
Bedroom Livingroom
Bedroom
32.D' 24.0'
Second Floor 1,184 st
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a f�tlp
Y �
No.. :.._ ��.. Fim......,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. d.W.N......OF....... A.P..AI.S "g�'��-•----••-----•-•----
Appliratinn for Ditivnsttl Works Tonotrnrtion thrutit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
System at:
................__..C.�4M..Q.....�P._ ;._.{� E.. .�:... ............-----L=-°--...--3-•-----•-------•---------- ------------- -------
Loc tion- dress
r Lot No.
• C 11i1.�_X"4. ...... Gi 4— _Q.cS1.'.,11.1D�..... --r`��L 5 .1..`.!.. ...........--•--......!�![.�? ..
�y J l�Awne ,6, S11.... J. d ess ; �..Q J
.....--..Tdof �.5--------JCY)7.f 7 GFe--------------------------------------- ------................- .. - -. .... --
� Installer Address
V Type of Building Size Lot.. .�..0/.6._..Sq. feet
Dwelling—No. of Bedrooms.................3f 7.._...._...._.....Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
Otherfixtures ---------------------------------•-----------•---•-----•-•--•---•--------------------------•---------------------••----••••---•--------•------------
W Design Flow...............................✓�..-`�_...gallons per person pqr/davy Total d�ily flow__._...................3 O_...._.galonAs.
WSeptic Tank—Liquid capacityMQa.gallons Length...-a... Width.","... Diameter__—.__. Depth---�,.�'_....... '(
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------f----------- Diameter./Z..--.O..-- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box Dosing tank ( ) a
.S E'NGje�- 4SOe, LAVe Date-----!'' Ve,' /01..��
Percolation Test Results Performed by....-, .............. ... 8'
aTest Pit No. 1........v__minutes per inch Depth of Test Pit___- Depth to ground water.___,(./V4VV.__.
Test Pit No. 2._.._._v..minutes per inch Depth of Test Pit.15.6...... Depth to ground water-----N a!✓.4G____
O Description of Soil----D -/_Z..._.-_�0�5 0_!... ...IZ 3�.----C � r 3 J� ..... am'v...I
(xj Si4NP
--- .------
-
Z -•---- -------- --- • . .............................-..................................-••-•-------------•----------•-----...•------••------•---•--•------•-------------•--•----•-----------......
V Nature 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 TIT- 5 of the State Sanitary 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.
Signed-------- - •- -•.....-............. .............................
.-.0.
Date
Application Approved BY .cf,� = ... �P. '.�
Application Disapproyedor the ollowing reasons:----- � -•, �a= ,�" -���----.�-'`-��Date 'Ire�"�
Permit No......... ��.................... Issued....� .... *...............
Date
ar ►fig
THE COMMONWEALTH OF MASSACHUSETTS r �M tyY?
BOARD OF HEALTH `
............. ........
......................................_._.__..w•._..._....._.....................
ApplirFatiun for Disposal Works Tonstrurtion Prrmit
Application is hereby made for a Permit to Construct ( Xj or Repair ( ) an Individual Sewage Disposal
System at: _
................_.....C a,li.. ....... .... -` - .................................................
Location-Address 6lei l� or Lot No
a E �nn wner 6 > Ade.ss-•---fi ....�c =
..... ......
Insta
Address
Q Type of Building Size Lot.._`_'. ___ Via_t: __.Sq. feet
U Dwelling—No. of Bedrooms.................` ........._._........Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ............................
Q --
W Design Flow.............................. ..gallons per person per day Total daily flow--- ..gallons
WSeptic Tank—Liquid capacity �.... _gallons Length „.. ." ._`Width.# P_ .t'."Diameter.-.�'...__ Depth...: -.._';t
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.__.__..,/........... Diameter..LL1._...2_ Depth below inlet.................•.. Total leaching area..................sq. ft.
Z Other Distribution box (Y.>) Dosing tank ( )
Percolation Test Results Performed by. `.�` ............. .._. ... Date..................................`=_
0-4 a
a
Test Pit No. 1.........:f .minutes per inch Depth of Test Pit.... ..... Depth to ground water____::£_................
ri, Test Pit No. 2.........2____.minutes per inch Depth of Test Pit__.tA ._':___ Depth to ground water------ :-f.'-__L'._
a ._.
Oi �,S r ••Z!..;a.•.r .. 10......y.,. .._ 't.--••{ �� - '� "` } l............................................. •r,# *s.......-=r,
Description of Soil ..:.. .......... .... .... ..... ---•---- ;;-- ----
x r
••••----••••----------------•.........-••--•------••--••••-•-••-•----•••••..............---••:.._...---••----••-•••••-•-•-••••••....-•--.....-•-•--•--•-•......---••-••-•------......-•-••----•-•....._.
U Nature 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 TITIL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been�ssued by the board
of health.
Signed ....... ( °= -_1.................
Date
Application Approved By.............. ;� ..,� ........................ ..........
Date
Application Disappproved[ for the fi3'llowing reasons:......../..................._ _�� }e .....
,. - w *si--.._.....�---•• r�-�,;;-• ..... ....�. - Date .�. '���
/ r . r
Permit No..........�._.�._:.-�r--��----••-•-----------. IssuecL-----=••--•=-=---D�---•--•,.-----•-------------.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
• 6 f .w.
t..�.......a...:.......OF..... ...._... ......:.. .........x.......................
Trartifiratr of TompliFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by........................111�1 ..... .....----------------------------------------_.. -•--••-•....._
o I staller
at----------- c.� . .... -- .�-1✓ d. ,..
has been installed in accordance witl the provilions of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No....... --------- dated_.............................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. r1l
:.�'-"�DATE.......... �'f` r ' ... Inspector. r r� '�� ' -.....
THE COMMONWEALTH OF MASSACHUSETTS
BOARD_OF HEALTH
Disposal Yorks Tonstrurt on rinutit
Permission is hereby granted.............. i�.vr t-.. r =£ A -•-----•-----•-------•--•-----•.----------------..-.-----.-------•-------
to Construct (� or Repair ( ) an Ind'i�idual Sewage Disposal System
atNo--.................L; ram^�`r-•---•--�J �..�c a,.. ..... --•-----r - ----•---
Street
as shown on the application for Disposal Works Construction Permit No...9�._ _/�� Dated..........................................
- ----•- -------------------------------
DATE................ --_./..1.6-------------•-------•--------.-----• /
�oard of Health
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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Te-'ST Pe,--FORM Ev 89
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TOWN OF BARNSTABLE
LOQAT-ON L67 3 M4 C 1 q(h6e SEWAGE # �-
VILLAGE P� I Cr)'�l�o/I C ASSESSOR'S MAP & LOT
b
0 `
INSTALLER'S NAME & PHONE NO. kT'YAeS ChaCe 5- 6-- '77M
SEPTIC TANK CAPACITY
< i ,u .
/
� LEACHING FACILITY:(type) (�X� f� ; 7— (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATERPLkBl'C-
BUILDER OR OWNER �P�Yl� 1 N;c ker so/j Wa
DATE PERMIT ISSUED: 0-
DATE .COUPLIANCE ISSUED
VARIANCE GRANTED: Yes No
vv
TAl-Uk"
No.. ��...:3.1._ Fss..., .....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliration for Disposal Works Tonstrurtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address j �' -- or Lot No.
......................^^ ........... .................... ......... ...._.... ._....................- ...................................................................... _
Owner ess
Installer //Q Add of ss�
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--• .............................Expansion Attic ( ) Garbage Grinder V/(b
'4 Other—T e of Building No. of persons-__--__. Showers — Cafeteria
Q, Oth fixtures ----------------------------••--
Design Flow........ .................................gallons per person er day. Total doily-flow............................................gallons.
W
G' Septic Tank—Liquid'ca.pacity'/Zgegallons Length___ --------- Width... '�:_...____ Diameter________________ Depth---_-----------
Disposal Trench—No. `.................. Width.................... T tal Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No.l P.v-___-_ Diameter-----a---------- Depth below inlet---..._.------- Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. I................minutes per inch Depth of Test Pit-______-_-_____.__-- Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a �+ ------------ ---- �{
O Description of Soil-------•--_a�--- --- - -•--- t' —/.... ..
U ••-•-•--••-•--•---•-------------------------•• ... •-•--•--•------•----------•---•---------•-------------•.._...---••-••-----•-•--------.._......••••--•-----•--------'--'----•--•---------
?DV *
U Nature of epairs o Alterations nswer when applicable_ ._�'__ _�(�_ __.___
........... . -------3 ...........................................................----------...
.............................
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 Compliant Wbee issued by e board ofhealth.
Signed .. .... ... .. ........................................
a...
ApplicationApproved By --------------------------------------------------------------................................. ......--
Dace
Application Disapproved for the following reasons- ------- ---- ------------------------------------------------------------------------------......................................
---------------------------------------------------------- -- -------- ---------- -------------------------------------------------------------------------------------------- ........................................
Dare
� . . ...
Permit No. - ------------------- Issued ----...-- --------------------------------------------.....
Date
f
Nab%:. _ Fim
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for 11ispulittl Works Tonotrnr#inn jlqnfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................�-- - - - - --..... .-.....------------------------"------
Location-A`ddress or Lot No.
......................__......................- r-•..-._.--------._....•.........-...._.... -^-•-- ------•--•-•---------------.........--------------.............................._.....
Owner ti Addres
W �' !t_ .../ I t / �A__ill _ . �_ _l! �._,/2_/
.... r Installer— Y j �� I (/ddres1_j v: I l �✓ —
Type of Building . r / Size Lot------------------------ Sq. feet
aDwelling—No. of Bedrooms__..............................Expansion Attic ( ) Garbage Grinder)
p., Other—Type of Building __________________________•- No. of persons__...__/.................... Showers ( ) — Cafeteria ( )
dOther fixtures -----•----------------------------------•-•----•-----...-----------1------------------------------------------•--------------.................._...
W Design Flow....��+.�_.r.............................gallons per person per day. Total dailyflow............................................gallons.
WSeptic Tank—Liquid*capacity.v ....gallons Length___.......... Width--- Diameter............._. Depth................
x Disposal Trench—No.A................... Width.................... Total Length....._.............. Total leaching area--------------------sq. ft.
Seepage Pit No.r_v.®___.... Diameter.... ........... Depth 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 -DeO h of Test Pit.................... Depth to ground Water........................ t�
44 Test Pit No. 2................minutes per inch ry Depth of Test Pit______..,._._.._._.. Depth to ground Water---
..............s......
-
ODescription of Soil--------•- 1 ......0 "� M, � .4-e' ' .---- ---------------------------•-.- . ' .
---•- ---__. - -•-..........................................................---
--••------------------------------------------ -------•--------------------------•--•-•---------•----------------------- ..... -------••---•••-----•••-•••-------.. ---------------
U Nature of Repairs or Alterations—Answer when applicable-..!__A_iJ _...7_�+U__. .___. ,
`"
Agreement:
i
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.
v Signed n D y
/� J �� J..✓ / ........................ ...............Date.................
_....-. _
ApplicationApproved By ---..i------------------------------------------------------------------------------------------ / - -
ti.
Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------- ...................................
...............................................................................................>............................................................................................................... ----- ---------------------........
-' Date
Permit No -.. ---------------------- Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(fertifira to of d-1-IIntylialtre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repair )
by---......... y� '-� 1.. �.t. r��..'....
1mraller
at .........' .......---3.......... _1....................... ............1v)--f.�-r: _.� �� _......1�Q 1�`Q�c„�� .:,� �f
` has'been installed in accordance bwilb the pro'isions of'TITLE 5,oflThe State Environmental Code, as described in
the application for Disposal Works Construction Permit No. ............:................................... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ;
v
DATE...... -------------------------------�........... ... Inspector .-----------...... .,:r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.q� Z .c- TOWN OF BARNSTABLE
ioposal Vvr4s Tons#rurnatt rrrmi#
Permission is hereby granted.......... /a r- !ham.:::*:..J.Jr�..............................•. ......./........................................
to Construct ( ) or Repair ( an Individual Sewage Disposal, System 't��-, {�
atNo. .. 1%r�'1--�------- � ...........................•--•--•-----------...--•-.......
Street ��yy��
as shown on the application for Disposal Works Construction Permit No,��1:3.z_..._ Dated..........................................
................................... ........-•----.....-•............................_
Board of Health
DATE. ur?. .... .-..-•---------------------•--•---- r�.
FORM 3650E HOBBS 6 WARREN,INC.,PUBLISHERS v
TOWN OF BARNSTABLE
`-
LOC��.`Y'',ON �� ��� 4 040 SEWAGE # - 7S,
VILLAGE ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY d
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS�PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: g r 2-0-Lo
DATE COMPLIANCE ISSUED: _/�)
VARIANCE GRANTED: Yes No
L
C�j
-zz V
TOWN OF BARNSTABLE
TI 1
LOCAON AP 0 ,P e� SEWAGE #
'VILLAGECvti ASSESSOR'S MAP&`L'OTT -13�i OOj
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
3C ,
Al
BA as
Qc 3a�
cc. alb
L .13 J/ 1 U WIN V 1. b Atcly J 1 Ab LL
LOCATION d/� ,i� - SEWAGE #
�' �/oG�13�603
VILLAGEv ASSESSOR'S MAP & L
INSTALLER'S NAME& PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) Ad= zok2 G S (size)
NO. OF BEDROOMS
BUILDER OR OWNER ✓ n` B
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility _� Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet .
Edge of Wetland and Le ac g Facili (If any wetlands exist
within 300 feet of c g ) Feet
Furnished by i
ty
� r