HomeMy WebLinkAbout0276 PHINNEY'S LANE - Health �76 Phinney's Dane
Centerville
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UPC 12543
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
R MAP 'VrD
PARCEL NOV 2 9 2004
�� 5-�-- TOWN OF BARNSTABLE
TITLE 5 HEALTH DEPT.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 276 Phinnevs Lane
Centerville, MA 02632
Owner's Name: Steve Ploen
Owner's Address:
Date of Inspection: November 18, 2004
Name of Inspector: (Please Print) James M. Ford
Company Name: James M.Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508)862-9400
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(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs Fu er Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: November 19, 2004
The system inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector.and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 276 Phinnevs Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ 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:
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.
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 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 276 Phinnevs Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**. Method used to determine distance
**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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 276 Phinnevs Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped_.
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 276 Phinnevs Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ _ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ _ Was the site inspected for signs of break out?
✓ _ Were all system components,excluding the SAS,located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
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
✓ _ Existing information. For example,a plan at the Board of Health.
✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 276 Phinneys Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4(per as built card) Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: I
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings,if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): epd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Pumped in May 2004 per owner
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed 7114193-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 276 Phinneys Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC _other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 20"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 31"
Scum thickness: 1"
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: 12"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs o leakage
GREASE TRAP: None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 276 Phinneys Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: v1 (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
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.):
The D-box was level and clean. No solids were present.
c I
PUMP CHAMBER: None (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.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 276 Phinneys Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 2-6'x 6'(1000 gal.)
leaching chambers,number:
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.):
One nit 01) had]'of liquid on the bottom. The scum line was approximately 2'up from the bottom There did not appear to
be any signs of failure. The bottom to grade was 9. The other pit 02)had P ofliguid on the bottom The scum line was
approximately 2'up from the bottom. There did not appear to be any signs of failure The bottom to grade was 9'
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
PRIVY: None (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.):
9
Page 10 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 276 Phinnevs Lane
Centerville, MA
Owner: Steve Ploen
Date of Inspection: November 18, 2004
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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10
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 276 Phinneys Lane
Centerville, AM
Owner: Steve Ploen
Date of Inspection: November 18, 2004
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 15 +/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours ntggs
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how g
you established the high round water elevation:
Y g
Using Barnstable topographic and water contours maps, the maps were showing approximately 15'+/-to ground water at this
site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report.
11
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Y ^X
Logged In As: Parcel De Thursday, March 22 2007
Parcel Lookup
Parcel Info
, ..............�...
Parcel ID 1230-134 DeveloperLet LOT 1
Location i276 PHINNEYS LANE Pri Frontage j165
....... .....
Sec Road i SecFrontage
village;CENTERVILLE Fire District JC-O-MM
_. .. .._._... v .............. . .�
Sewer Acct Road Index;1242
InteractiveMap
4 �I
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Owner Info
__....,,.,. ._._... .,,. _ ..__.. .... ...__ _...
Owner=;DECASTRO, EVANDRO Co-owner'
Streets 276 PHINNEYS LN Street2
City ICENTERVILLE state MA Zip i02632 Country USA
Land Info
__.
Acres 0.90 Use Multi Hses MDL-01 Zoning `RD1 Nghbd 0104
-_ _ __
Topography Level Road Paved
...._ ............................................. .............
utilities Public Water,Gas,Septic Location
Construction Info
__. . ........ ............................._ . ........
Building
Year __.. _. Roof ,_...... _. Ext _..._ ..
Built°1952 Struct?Gable/Hip wall Vmyl Siding
..........
Effect° �� yy Roof ����� �� � �� ���� �� AC
Area ;2�23 I Cover Asph/F GIs/Cmp Type None
Int Bed
style Ranch wall !Drywall Rooms 14 Bedrooms
Model Residential Int Rooms 12 Full + 1 H r 31,E
Floor
_...m.. Heat __ �A_ ___ Total
verage _ .. ._
Grade ;A Type 1 Hot Water Rooms'$ Rooms ;
.,. ,.... E;
Stories,1 Story Heat Oil Found-
Fuel ation
Building 2 of 2
Year Roof Ext
Butt i1985 � struct Gable/Hip Wall Shingle
Effect .. ,_ _. Roof _,.... AC
Area 601 Cover Asph/F GIs/Cmp Type None
y,
Style ;Gotta e Int ID wall Be, 1 Bedroom
9 ... Wall ___ Rooms: _. ..,
sr
...,- ........ .. .... ... ......
Intr
Model ;Residential Floor Rooms 0 Full + 1/2
_.
Heat _ #a
GradeAverage Type None R Total ooms 1 Room
Heat i� � " 9Found-
stories 1 Story FUei None 1 ation
Permit History
......... .....................................__ .........
Issue Date Purpose Permit# Amount Insp Date Comments
5/1/1993 B35880 $30,000 1/15/1994 12:00:00 AM CE ADDIT'
Visit History.
Date Who Purpose
4/7/2005 12:00:00 AM Gary Brennan Meas/Est
11/4/2003 12:00:00 AM Paul Talbot Meas/Est
4/18/2001 12:00:00 AM Paul Talbot Meas/Listed
6/15/1994 12:00:00 AM ME
Sales History
.. ......... ......... ..........
Line Sale Date Owner Book/Page Sale Price
1 12/10/2004 DECASTRO, EVANDRO 19333/122 $380,000
2 5/30/2003 GABRIEL, RICHARD J TR 17009/205 $356,900
3 4/28/1998 CLAUSSEN, JOANNE M 11388/045 $175,000
4 12/15/1984 BROWN, DANIEL E & MURIEL S 4344/044 $69,900
5 REGAN, BARBARA J 2342/192 $0
- Assessment History
......... _ ......... ......... .............
Save# Year Building Value XF Value OB Value Land Value Total Parcel Value
1 2007 $242,500 $2,400 $500 $129,600 $375,000
2 2006 $222,100 $2,400 $500 $133,000 $358,000
3 2005 $203,300 $2,300 $600 $166,300 $372,500
4 2004 $164,500 $2,300 $600 $166,300 $333,700
5 2003 $148,600 $2,300 $600 $47,500 $199,000
6 2002 $148,600 $2,300 $600 $47,500 $199,000
7 2001 $113,200 $2,300 $10,000 $47,500 $173,000
8 2000 $91,400 $2,300 $10,400 $47,700 $151,800
9 1999 $91,400 $2,300 $8,400 $47,700 $149,800
10 1998 $91,400 $2,300 $8,400 $47,700 $149,800
11 1997 $96,000 $0 $0 $42,900 $145,900
12 1996 $96,000 $0 $0 $42,900 $145,900
13 1995 $96,000 $0 $0 $42,900 $145,900
14 1994 $67,700 $0 $0 $34,300 $105,500
k =` 1�5 1993 $67,700 $0 $0 $34,300 $105,500
16 1992 $77,100 $0 $0 $38,200 $119,300
17 1991 $80,200 $0 $0 $76,300 $164,900
18 1990 $80,200 $0 $0 $76,300 $164,900
19 1989 $80,200 $0 $0 $76,300 $164,900
20 1988 $54,700 $0 $0 $38,200 $100,000
21 1987 $54,700 $0 $0 $38,200 $100,000
22 1986 $54,700 $0 $0 $38,200 $100,000
Photos
Town of Barnstable Geographic Information System March 22,2007 -
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DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:230 Parcel:134 a
Selected Parcel
boundary determination or regulatory interpretation. Enlargements beyond a scale of
1"=100'may not meet established map accuracy standards. The parcel lines on this map Owner:DECASTRO,EVANDRO Total Assessed Value:$375000
are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.90 acres Abutters
boundaries and do not represent accurate relationships to physical features on the map Location:276 PHINNEY'S LANE
such as building locations. Buffer f!
2
DA 13/6/98 3
N
PROPERTY ADDRESS : 276 --Phi
REcc�ivE0 �.
Centerville,Mass AR 2 4 1998 �'
02632 TOWN OF BARNSTABLE
HEALTH DEFT
On the above date, I Insp�ecte-d the "ptic system at the above__e.ed'ress
Tnls system consists of the following:
1 . 1 -1500 gallon septic tank.
2 . 1 -Distribution box.
3 . 2-1000 gallon precast leaching pits. 6 ' x8 '
6a5ec on my Inec�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.
SIGNATURE
Name : J . P . Hacomber Jr•..
Company: J_ P_Macoc)ber 8— Son- ,Inc .
__Centervi ! Le `Mes9__02632
Phone : ---5�..?75-3338------- I
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARR;,rtTY
+
.)OSEPH P. MAGOMBER & SON, INC.
T+nkrC�upoolr-L++thllolC�
Pump*d L IntUll►d
Town Sower Connoctlons
P.O. Box 60 ' Centerville. MA 02632.0066
775.3339 775-6412
r' COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 617.292.5500
WILLIAM F.WELD TRUDY CC
Govcmor Sccrc
ARGEO PAUL CELLUCCI DAVID B STRI
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissi(
PART A
CERTIFICATION
Property Address: 276 Phinneys Lane Centerville Address of Owner:
Date of Inspection: 3/6/9 8 (If different)
Name of Inspector: Joseph P.Macomber Jr.
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J.P.Macomber & Son Inc.
Mailing Address: A,, 6r, Centerville,Mass . 02632
Telephone Number: 5()A-775--11-1A
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurat,
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper iunction and
maintenance of on-site sewage disposal systems. The system:
asses
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date: 5'F
The System Inspecto s all submit a copy, of this inspection report to the Approving Authority within thirty (30) days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submii
the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system own
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
�A] SYSTEM PASSES:
�r� I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upc
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not.
,4[�Q The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; c
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or ex-filtration, or tan
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web: httpanvww.magnet,state.ma.usrdep
0 Printed on Recycied Paper
i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass .
Owner: Dan Brown
Date of Inspection: 3 16/9 8
B) SYSTEM CONDITIONALLY PASSES (continued)
�d Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
NCO The system required pumping more than four times a year due to broken or obstructed pipets). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
C) FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH:
—4)h Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
._�D 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) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
,gyp The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
�Q The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
IUD The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
d16 The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance Vlf (approximation not valid).
3) OTHER
(revised 04/25/97) page 2 of 10
�3
r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass .
Owner: Dan Brown
Date of Inspection:3/6/9 8
D) SYSTEM FAILS:
You must indicate ei;-.er "Yes" or "No" as to each of the following:
AZO I have determined that the system violates one or more of the following failure criteria as defined in 310 CN1R 15.303. The bans
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cornea
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloadedor clogged SAS or cesspool.
Ars
liquid depth in racbpaeF is less than 6" below invert or available volume is less than 1/2 day flow.
_ ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped ,Q.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supp�y.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
Q LARGE SYSTEM FAILS:
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
&lj�' the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/25/97) P&ge 3 of 10
\J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 276 Phinneys Lane Centerville,Mass .
Owner: Dan Brown
Date of Inspection: 3/6/9 8
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks 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 available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
2 _ The site was inspected for signs of breakout.
_ All system components,Acluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
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 facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of
5ub-Surface Disposal System.
_ Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable) (15.302(3)(b))
zevlaed 04 25/97) P&q• 4 of 10
f ��j
Li
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM.INFORMATION
Property Address: 276 Phinneys Lane Centerville,Mass .
Owner: Dan Brown
Date of Inspection: 3/6/98
FLOW CONDITIONS
RESIDENTIAL:
Design flow: Yyb g d./bedroom for S.A.S.
Number of bedrooms:E
Number of current residents:
Garbage grinder (yes or no):&V
Laundry connected to system (yes or no):A,4
Seasonal use (yes or no): AjP
Water meter readings, if available (last two (2) year usage (gpd): A
Sump Pump (yes or no):, L4- jg y 1 �rVA,44_ �.. ; 69 4
Last date of occupancy:
COMM ERCIAUINDUSTRIAL:
Type of establishment: A14
Design flow: X,7A Rallons/day
Grease trap present: (yes or no)
Industrial Waste Holding Tank present: (yes or no)Ld
Non-sanitary waste discharged to the Title S system: (yes or no)10f
Water meter readings, if available:z&}
Last date of occupancy: �A
OTHER: (Describe)
Last date of occupancy:�.J,�
GENERAL INFORMATION
PUMPING RECORD and source of informal on:
System pumped as pan of inspection: (yes or no)A�o
If yes, volume pumped: Vof gallons
Reason for pumping: U�
TYPE OF SYSTEM
_, Septic tank/distribution box/soil absorption system
_ Vp Single cesspool
x/0 Overflow cesspool
.f)U Privy
_AL Shared system (yes or no) (if yes, attach previous inspection records, if any)
A-1-4 I/A Technology etc. Copy of up to date contract)
Other A41-0
APPROXIMATE ACE of all components, date installed (if known) and sourc�e of information: �ivUa� o
_ r ✓�ySTiti1 '?--'I—,/`j a�/�i�IQrfI>y�r z' Yeti . its
Sewage odors detected when arriving at the site: (yes or no)10
(rwls�d 0�/ZS/97) Page 5 of 10
f
_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass.
Owner: Dan Brown
Date of Inspection: 3/6/98
BUILDING SEWER:
(Locate on site plan)
Depth below grade:
Material of construction: cast iron Z40 PVC _other (explain)
Distance from private water supply well or suction line
Diameter _
Comments: (condition of joints, ve ting, evidence of leakage, etc.)
.� A , 61C ZgAkA2P i
SEPTIC TANK: l SDO 9091410t/5
(locate on site plan)
Depth below grader
Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain)
If tank is metal, list ageJZIs age confirmed by Certificate of Compliance/ (Yes/No)
Dimensions: $`p 0W e 6'' 7`
Sludge depthJ ��
Distance from top of sludge to bottom of outlet tee or baffle:Z/Z�e
Scum thickness:rl�
Distance from top of scum to top of outlet tee or baffle;//�
Distance from bottom of scum to bosom of outlet ee o baffle:
How dimensions were determined:
Comments:
(recommendation for pumping, conditi of inlet and outlet tees or baffles, depth 0(liquid level in relation to outlet invert, structural
integrity, ev deice of leakage, etc.) `
GREASE TRAP:
(locate on site plan)
Depth below grader
Material of construction�i4concreteVAmetal /A1Fiberglass4y&Polyethylene42 other(explain)
.1l/4
Dimensions: AJl9
Scum thickness: A
Distance from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to bottom of outlet tee or baffler
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
T
(revised 04/25/97) Page 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass .
Owner: Dan Brown
Date of Inspection: 3/6/9 8
TIGHT OR HOLDING TANK:gtWe(Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grader
Material of con struction:gLconcreteA1AmetaIANAFibergl ass :4Polyethylene,(yother(explain)
A1,4
.rJA
Dimensions: /4
Capacity: A114 gallons
Design flow: Allie gallons/day
Alarm level. AIA Alarm in working orderAtA Yes;4A No
Date of previous pumping: �I>�i•,
Comments
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:-
(locate on site plan)
Depth o hcu,d level above outlet invert: (9
Comments.
(nZ if I vet and distribution is equal, evidence of solids carryover, evidence of leaka a inta or out of box, etc.)
410- �B ev �r.
PUMP CHAMBER://.
(locate on site plan)
Pumps in working order: (Yes or No) Ao
Alarms in working order (Yes or No)-424
Comments:
(note condition of pump chamber, condition of pumps and appunenances, etc.)
I't"Z40
(rw is•d P.g• 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass.
Owner: Dan Brown
Date of Inspection: 3/6/98
yam.
SOIL ABSORPTION SYSTEM (SAS) �L l�C/
i �
av
;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: O
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number: 0
Alternative system:
Name of Technology: t ` i '42, 7?Cerk,
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) �.
r 73 440�:_azL
.1
CESSPOOLS: 43've
(locate on site plan)
Number and configuration: 04
Depth-top of liquid to inlet inven: '4)A
Depth of solids layer: .d4A
Depth of scum layer: /I/p
Dimensions of cesspool: A114
Materials of construction:
Indication of groundwater: N
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
/l.117- 11 o ]�
PRIVY: i zv(i
(locate on site plan)
Materials of construction: /y/ Dimensions: mot/
Depth of solids: /1/14
Comments:
(note condition of soil, signs of-hydraulic failure, level of ponding, condition of vegetation, etc.)
(r•v1s•d 04/15/97) Y•g• a of 10
f
'G
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass .
'Owner: Dan Brown
Date of inspection:3/6/98
SKETCH OF SEWAGE DISPOSAL SYSTEM:
nclude ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (locate where public water supply comes into house)
i 22N t-z/
� � II
(rvvisod C//25/91) Page 9 of 10
I SUBSURFACE SENYAGE DISPI: t SYSTEM INSPECTION FORM
I . : C
SYSTEM INFOI: .. :ION (continued)
Property Address: 276 Phinneys Lane Centerville,Mass.
Owner: Dan Brown
Date of Inspection:3/6/9 8
Depth to Groundwater Lf Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_Z/Obtained from Design Plans on record
Observation of Site (Abutting property, bservation hole, baserrttrl-simp etc.)
__�Determine it from local conditions
heck with local Board of health
Check FEMA Maps
heck pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Ground•rarerElevation. Must be completed)
Used Groundwater contours Map.
Gahrety & Miller Model
12/16/94
(revisal 04/25/97) Pace of 10
0
•rrnr+.—., rn--T,r-,.,ir,,,.•..rr.,v-,.n rer..,r...:•.�.-.:,mr:,,.-.rrtn,,,rn.�..a�sr..az, m-srTe�,.,_c.r,'.,�,_„--,-...--.—
TURN OF Barnstable. BOARD OF HEALTH
Sl1I1SURFACE SEHAOE DISPOSAL SYSTEM INSPECTION FORM - PART D CERTIFICATION
`� �•••�. -r••.-•. .--..tl^.�.--n.r.r..n•rt1-n rRfr ss•trT.elR,:rz'1+•9 ur*Z 1nmr•rIT*,eaar mZTTac.•H1TRf mnn•mrrr+t rmr+.r.r.-:rrrr--. •—.
—TYPE OR PRINT CI.EARLY—
PROPERTY INSPECTED
STREET ADDRESS 276 Phinneys Lane Centerville,Mass . '
ASSESSORS MAP , BLOCK AND PARCEL # °� 3 O 3
OWNER' s NAME Dan Brown-
PART D - CERTIFICATION I
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Son Inv`.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street Town or City StAt• 11P
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 790 - 1 578
N
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 :
Sys teui 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 failtire
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED* \
The inspection which I have con itcted 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 Date 316/98
One copy of this certification must be provided to the OWNER, the BUYER
( Where applicable ) and the BOARD OF 11BALl-H.
* If the inspection FAILED, the owner or"'*operator shall upgrade • the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 310 CMR 16 . 305 .
partd . doc
TOWN OF BARNSTABLE
Lt T<���t ��� ��►^AVIS _l.�^L SEWAGE #
� ASSESSOR'S MAP & LOT
INST'ALL..FR'S NAME&.PHONE NO.
SEPTIC TANK CAPACITY S�
LEACHING FACLLM: (type) a' �oX(o� l"i �1 (size) /�JflO
NO.OF BEDROOMS fJ
BUILDER OR OWNER
~ PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
withinz300 feet of leach ng facility) Feet
Furnished by l/I on
J -
A.r
i
8ALk A_ (3
OIL o i ai
s 3 as as
� as
e ' 1• TOWN OF BARN_ STABLE
LOCATION Z 76 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT 1�0 , I3
INSTALLER'S NAME & PHONE NO.
r-r _
SEPTIC TANK CAPACITY J,(S-00
LEACHING FACILITY:(type) (size) 0C1O
4
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: j j 3
DATE COMPLIANCE'ISSUED ] -
VARIANCE GRANTED: Yes No %
` t 1
,
TOWN OF BARNSTABLE
,LOCA�-n1! ON �.! SEWAGE #
VILLF'GE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY 7'
LEACHING FACILITY: (type)( ° (size)
NO.OF BEDROOMS
BUILDER OR OWNERS
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) y Feet
Edge of Wetland and Leaching Faci 'ty (If any wetlands exist
within 300 t of leach aci ' Feet
Furnished by
3 - -
�k
No....7 :i30.00
t
THE COMMONWEALTH OF MASSACHUSETTS
APPRov99 BOARD OF HEALTH R a3 O l 3 q
Barnstable Consenr� r+� �mL
TOWN OF BARNSTABLE
S l _F
Si t � it ttnt lr lipnial li arkq Tomitrnr#inn Frrmi#
Application is hereby made for a Permit to Construct ( ) or Repair 'CX-1 an Individual Sewage Disposal
System at:
276 Phinne,.-. Lane Centervilll
...............................a... ----•--•-----------------------••-•-------•--•... --------------------------------------------------------------•.......------------------.-------
Brown Location-Address or Lot No.
...:.............................................................................................. -•---••-•--••----•---------•-••••....•----•-••...............---•........................0........
W J.P.Macomber Jr. Owner Address
Installer Address
Q Type of Building Size Lot............................Sq. feet
V Dwelling— No, of Bedrooms..............4...........................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures ------------------------------
d ----------
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.
3 Seepage Pit No--------.-_-----.-_ Diameter.................... Depth below inlet.................... Total leaching area.........-........sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
0.4 W
Percolation Test Results Performed by................... ...................................................... Date........................................
,.� Test Pit No. 1----------------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........................
Ra' ---- --•• -
0 Description of Soil....... _ ..._.Crrave l
............ . ..........................................................-
W
U ..................•••....-•-----•--•••---•-...--••--•-•..._._..............-------•--••-•••••-•----•--•-•-••-•--•-------•-••---•---.._...---••••--•-•-•-•----••••••••--•••-•-•-•--....-•................
W
U Nature of Repairs or Alterations—Answer when applicable..-Omitting existing
c e s sp?!?j . .
Installing. 1-1500 gallon tank—l—distribution box-2-1000 gallon
----------------------Teaching -Pigs packea.._in -stone:-----------------------------------....:..--------------•-•---..............................
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 Complia ce has ee�iss�e�d by the bo d of ealth.
Signed . �------- - . ...1............... .....5/1-7/93...........
Date
Application Approved By ................... ....... . . ........................................:------ .....v�'.—..— -..�' ...
Application Disapproved for the following reasons: .. ...... ............. . --...................... ......... ...........................................
................................................................................................................................................................................................................ ................ ..................
Date
PermitNo. .........�.3. V.a-1... .............. Issued . ...................---..........................................
Date
No....9j.:.LL j ` - Fas.... ....3��..�J
THE COMMONWEALTH OF MASSACH'USETTS
BOARD OF HEALTH R ,� 3
TOWN OF BARNSTABLE
�AVV iratiutt fur Diripuuttl l urk,i Towitrnrtiun er'n it
Application is hereby made for a Permit to Coristruct ( ) or Repair -,M `an Individual Sewage Disposal
System at: . x
276 Phinneys Lane Center�rilll
...........................................................•----------•--••---• --•---------------------------•---•-•-•---• ---••••...-••-•---...-•--•--•-•••--•---••----....-•-
{ Location-Address or Lot No.
Brown
......................-.......................................................................... --•-•-••••---------••--•-•-•-•---•••••----••-•--•••-----•----••--••--••----•-------.............--
Owner Address
W J.P.Macomber Jr.
-------••-•• •••••••••--••••••••--•••-...-•••-•............•..................................
Installer Address
UType of Building Size Lot............................Sq. feet
.. Dwelling x No. of Bedrooms.............4-.------------------..._.-Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ----------------------- ---- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q Other fixtures .
W Design Flow............................................gallons per person per day. Total daily flow................-...........................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........................................
a
Test Pit No. I................minutes per inch Depth of Test Pit.-.-- ... Depth to ground water--......................
fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................--..
04 ` •--•--- - -------------
D Description of Soil Sand ._ Crra.Te l ..........................................................
x
W
UNature of Repairs or Alterations—Answer when applicable.--Oml t t i n g e x i s t i n F cesspools .
Installin7. 1-1500 -anon tank-l-distribution box-23: 000 gallon
. • .....................•-.......••.-••••-
Agreement: leacfiing pigs pacKecI in s orie:
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 I ealth.
Signed • . - .............................. . /......... ........................................
� Dace
Application Approved By ................. ------- ----- c=,,�---,� �, . 3...
....--- to '--....
Application Disapproved for the following reasons: ....................... ..... . . ........._......................... ............ ..........................
........... ........ . ...................... . ........................................ ....................
Dace
PermitNo. ........-1�.-..... -------------------------- Issued ........................................................................
Daze
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C�Ertifirate of Tantylianre
THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repairedx..XXX)
J.P.Macomber Jr.
by ...._-------------_------------------_------------------....._..-----------..._...---.._--------------------
at .......276 Phinneys Lane Centerville
... ...................................................._------------------------------------ _...._.......-----............---...-----....---.......-----------------------------------------------------------
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. ..._ -... off../_.......... dated ._.... .................._..........._._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............._.._.........._.... ;7_ �. ✓.-._9.'.._ _
.... ..... Inspector ---......... ....... .....................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CC}}No.... TOWN OF BARNSTABLE FEE .
$ 30 00
L.3- •-- .........••• -•.....
11iupuuttl Vorkii Tunitrudiun "rrmit
Permission is hereby granted......J.P.Macomber Jr.
------------------------------------------------------------------------
to Constrtt t ( ) or Repair (X ) an_Individual SSewage Disposal System
at No
2 ('- Phinneys Lane Centerville-
Street
as shown on the application for Disposal Works Construction Permit No�3. ��.-.. Dated..................................-........
•--• . . •. .....
tOi y Board of Hcalth
DATE............' � f 7 ..............................
FORM 36508 HOBBS Q WARREN,INC.,PUBLISHERS