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Home My WebLink About0002 FIDDLERS CIRCLE - Health 2 FIDDLERS CIRCLE, HYANNIS A= 288 151 �j I �I i i TOWN OF BARNSTABLE WCATION SEWAGE # V-2,LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � f (size) , NO. OF BEDROOMS BUILDER OR OWtNER PERMITDATE: Y 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 Leaching Facility(If any wetlands exist �•within;rJO fee ee =lityFeet Furnished by f�, __ �- J �;: � ,,, v -� � � C : � � r � � .v .6�fs , � �� t — �, � � - � �� 6 ! �°O�� l7 � l ,, ., �� ,A No. 3q Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplitation for Disposal *pstPm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon()( ❑Complete System ❑Individual Components Location Address or Lot No. A F nAX&'e5 QrLcLC Owner's Name,Address,and Tel.No. WAN N 6 5TePHc_iJ 6QrA 1 L h ANNtN C—, Assessor's Map/Parcel a ?SJ/57 ;L F EL $ 1JC DR Nrg4c—Z m A Installer's Name,Address,and Tel.No. y'Q$—�f77- 9977 Designer's Name,Address,and Tel.No. CAPEU-)IDE E&17WQi:5-c-5 t t_ 5`r NA NPOE Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) .413Ak)wxl Z=_)asrrAl& s oyr(cs s y_<rEm Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in . accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issu*this of Hea Dateor Application Approved by Date Application Disapproved Date for the following reasons Permit No. Date Issued lip/ No. Fee > THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes f. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 1 !: ftpYiration for Misposab6p4tetn Construrtion Permit Application for a Permit to Construct( ) Repair( ) -Upgrade( -) Abandon A ❑Complete System ❑Individual Components 3•. Location Address or Lot No. a F Iba(eRS GRcz Owner's Name,Address,and Tel.No. 4y&015 STEVH(;W Irr GrA t t- MANNrN Q } Assessor'sMap/Parcel p��g �� ;L 1=1EC 5MMG DR FAQ445R.IMA Installer's Name,Address,and Tel.No. SD$"07-'8277 Designer's Name,Address,and Tel.No. 'CAPEw1DE G(NTWAJSr_S u-c-. N/A 153 Go QZCt t_ ST MA5744 69a_ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd t Plan Date Number of sheets Revision Date 1 Title Size of Septic Tank Type of S.A.S. �h Description of Soil Nature of Repairs or Alterations(Answer when applicable) �3�41U tY�xJ I-�?ct�S`Cf 1�Cz S G?7(G S_ <rEM Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance_has been issued by this Board of Health. Date O Application Approved by /( 0 � �/ / Date; r Application Disapproved y ` Date / for the following reasons Permit No. ^, Date Issued ------------------------------------------------------------------------- --------------- ----------------------------------------. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(X)by C,AP&(& J I-b g &Q_Q,M 5;9'j (,Lc_ at r M l,C—Z S- Ct I kC kg (4'Y"j1(5 has been cons c�Ll /edd* acco d 'ce with the provisions of Title 5 and the for Disposal System Construction Permit No. "fed Installer C 4Pr..Uj(D,9;7 EKV T8CkJ_-Z9 UC Designer N/A #bedrooms Approved design flow gpd " ^ The issuance of this permit shall not be construed as a guarantee that the system will c' as designeeh. Date L) J I.) /6 Inspector f v ____________I________________________________.__.-_____)---- - - ___ No. Fee r`•� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at 1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio ust be co leted ithin three years of the date of this permit. Date Approved by Town of Barnstable Barnstable IKE ram, Board of Health BARN STABM MASS, 200 Main Street, Hyannis MA 02601 OlfD MPS 0`0 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL# August 21, 2015 Stephen and Gail Manning 2 Fieldstone Drive Palmer, MA 01069 IMPORTANT NOTICE: 288-151 RE: Show-Cause Hearing Dear Stephen and Gail, You are scheduled to appear before the Board of Health on Tuesday, October 13,2015 at 3:00 p.m. at the Town of Barnstable Town Hall, Hearing Room, second floor, 367 Main Street, Hyannis, for a show-cause hearing. This hearing will be held to show-cause why your property at 2 Fiddlers Circle has not been connected to Town sewer by the March 30, 2015 deadline. During this hearing, you will have an opportunity to be heard, present witnesses, and provide documentary evidence pertinent,to this case. If you have any questions please call the Barnstable Health Division at 508-862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, CHO Agent of the Board of Health STEPHE.-d R. MA`tNING TERESA.E. STEVENS October 1, 2015 Steve Goulet Capewide Enterprises, LLC O O 153 Commercial St. Mashpee, Ma. 02649 RE: sewer hook-up at 2 Fiddlers Circle, Hyannis Dear Steve, I have enclosed our check in the sum of$1,700.00 as a deposit for the sewer hook- up, along with a signed Sewer Connection Contract. We understand you will file with the Board of Health for any required permits, and it will not be.necessary for us to travel to the Cape on Tuesday, October 13 for the Show-Cause Hearing. Thank you, and I look forward to hearing from you once you are able to set a date for installation. Very truly ours, Y Stephen lk. ` -arming SRM/s encs. Thomas A. McKean, CHO Agent of Board of Health 200 NORTH MAIN STREET,SUITE 2 EAST LONG:'4EAD0\4,MA 01028 TELEPHONE 413.525.1119 / TELECOPIEP.:413.525.1904 / TOLL FREE:800.850.5775 H\'AN\L,M,I,SSACHUSETTS TELEPHONE:508.7 78.2548 �r►E ram, Town of Barnstable Barnstable Regulatory Services Department ANURNICaU l BARNSPABLE.p MASS. 4 039. Aim Public Health Division fp 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# February 6, 2015 GAIL AND STEPHEN MANNIN 2 FIELDSTONE DR IMPORTANT NOTICE PALMER, MA 01069 Map & Parcel: 288-151 DEADLINE APPROACHING According to our records your dwelling at 2 Fiddlers Circle, Hyannis, MA, should be connected to public sewer on, or before 3/30/2015. This is a reminder that all permits for your property need to be in place before this date, so that you are in compliance with the order letter sent 3/28/13. 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. 2) Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at(508) 790-6244. FOR ANY QUESTIONS/ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. i I Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health PAsewer connection\MAILING KM Sewer reminder no pump Yr2015.doc .. - .. . _.;. . . ova 1 .. OATE:._8/1.7/98 PROPERTY ADDRESS: 2 Fid-filers Circle West Hyannisport Mass . On the above date, 1 Inspected the "ptic system at the above address. This :system consists of the following: 9 1 . 1 -6 'x8 ' • block -cesspool . 2 . 1 -1000 gallon precast leaching pit. Based bn my Inscactlon, I certify the following conditions: 3 . This is not a title five septic .system. 4 . This ' is a sewage system. 5 . The sewage system is in proper working order -at the present time. . 6 . The present design is for a three• bedroom ,house. SIGNATURE: J� Name J P Macomber Jr, -- -.--- ----------- COmpany:'J, P_Macomber &_ Son•_Inc ; Address:_-8aac-6 b-----=A----.-- __Centervill,e , Mass__02.632 ` Phone: _508�ZJ_5..3338------- •- 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY LP.O. P. MACOMBER & SON, INC. Tan CeupoolrLe,ch(loldi Pump+d I' Installed Town Sower Connoctiont x 6G' Centerville, MA 02632-0066 77.5-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS U19, 0 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 WILLIAM F.VELD TRUDY CO Govcmor /j` Sccrc ARGEO PAUL CELLUCCI ry�C �� DA +D B.STRL Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ,� FORM 2 Commissic PART A 8 CERTIFICATION F ' Ce ,,y�1998 E1ai�n,_ Tung PT �r Property Address:2 Fiddlers Circle West Hyannis Address of Owner.5 ranklin Road Date of Inspection:8/17/98 port,Mass. (If different) L x ngton,�Mass. Name of Inspector: `Tn�h. P..Ma r mber Jr. �*.. A am a DEP approve: , ,i inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) 024120 Company Name: J.P.Macomber & Son Inc. Mailing Address: BOX 66 _Centeryille,Mass. 02632 Telephone Number: cO-8-=7.75-3338 CERTIFICATION STATEMENT 1 certify that I have personally d the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time o .:on. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage 11 systems. The system: __.,,/P asses Condi;V Passes Needs Evaluad n By the Local Approving Authority Fail Inspector's Signature: i 0 Date: The System Inspector all sub:. .)pyv of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a ;.. r,stem or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate it: D(fice of the Department of Environmental Protection. The original should be sent to the system own( and copies sent to the buyer, oble, and the approving authority. INSPECTION SUMMARY: 1, B, C, or D: AI SYSTEM PASSES: I have not found any .:ion which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria n, .:ed are indicated below, COMMENTS: BI SYSTEM CONDITIONALLI' S: _ 0 One or more system 1 ;;nts as described in the "Conditional Pass" section need to be replaced or repaired. The system, upo completion of the re, i or repair, as approved by the Board of Health, will pass. Indicate yes , or not determ N, or ND). Describe basis of determination in all instances. If'not determined", explain why not. The septic t:. .: ,�tal, unless the owner or operator has provided the system inspector with a copy of a Certificate of �. Compliance :!) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; o the septic t:. ..:)er or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is im:. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approves ;oard of Health. (revi*od 04/25/97) p4je 1 of 10 DEP on the World Wide Web: http://www.magnet.a Late.ma.us/dep {� Printed on Recyeded Paper U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2 Fiddlers Circle West HYannisport,Mass . Owner: Elaine Tung Date of Inspection: 8/17/98 B) SYSTEM CONDITIONALLY PASSES (continued) ,r 4&t 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 Nl> The system required pumping more than four 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 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: X+ Q 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: AJD Cesspool or privy is within 50 feet of a surface water 1�6 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: d0 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. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. 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 S ppm. Method used to determine distance 4 (approximation not valid). 3) OTHER (revised 04/25/97) Pegs 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. Owner: ELaine Tung Date of Inspection: 8/1 7/9 8 D) SYSTEM FAILS: You must indicate eiv,er 'Yes' or"No" as to each of the following: A10 I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis 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 gompohent 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 overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below inven 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 1O—. _. 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 supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any ponion of a cesspool or privy is within 50 feet of a private water supply well. Any ponion 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. E) 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 A-_f the system is within 400 feet of a surface drinking water supply 4)Y4 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) 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. i trovlsed 04/2S/17) D4y• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. Owner: ELaine Tung Date of Inspection: 8/1 7/9 8 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No f Pumping information was provided by the owner, occupant, or Board of Health. _k 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. _ The site was inspected for signs of breakout. _ All system components, eexkcluding the Soil Absorption System, have been located on the site. _A1,40L 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 djHerent from owner) were provided with information on the proper maintenance of Sub-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) 115.302(3)(b)) (revised 04/25/17) Pep• 4 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. Owner: Elaine Tung Date of Inspection:g/1 7/g g FLOW CONDITIONS RESIDENTIAL: Design flow: Wg.P;PJbedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):,d& Laundry connected to system (yes or no):A°c' Seasonal use (yes or no): ° Water meter readings, if available (last two (2) year usage (gpd): I P D Sump Pump (yes or no):_A—)2) Last date of occupancy:IC COMMERCIAUINDUSTRIAL: Type of establishment: A//A Design flow: gallons/day Grease trap present: (yes or no) 4 Industrial Waste Holding Tank present: (yes or no)_A�d Non sanitary waste discharged to the Title 5 system: (yes or no)/V/1 Water meter readings, if available: A)A Last date of occupancy: OTHER: (Describe) ✓� Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool � Overflow cesspool /000�7/4, Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of p to date contract? Other .L> APP X MATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no)" (revised 04/25/97) Day• S of 10 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:2 Fiddlers Circle West Hyanni sport,Mass. Owner: Elaine Tung Date of Inspection: 8/1 7/9 8 BUILDING SEWER: (Locate on site plan) it Depth below grade:- material of construction: cast iron _40 PVC o her (explain) /J Distance fromrriv o water s pp y well or suction lin e /b't Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear tight. No evidence of 1 Pakacle•cz ctam is 'rented through the house vent. SEPTIC TANK:"44-- (locate on site plan) Depth below grade: Material of construction:4?4concrete�metal ✓A Fiberglass.✓,&PolyethyleneMAother(explain) A If tank is metal, list age Is age confirmed by Cenificate of Compliance AZ&(Yes/No) Dimensions: Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffler_ Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: PJA _ Distance from bottom of scum to bottom of outlet tee or baffle:_ How dimensions were determined: A)1+ 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.) Septic tank is not nrPgPnt GREASE TRAP: L2&Vl _ (locate�on site plan) Depth below grade:,—AAO Material of construction:i✓ concrete.fAmetalo!LAFiberglass4i¢Polyethyleneo/2 other(explain) Dimensions: AM Scum thickness: Distance from top of scum to top of outlet tee or baffle:AW Distance from bottom of scum to bottom of outlet tee or baffle:2264r_ Date of last pumping: NA 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.) Grease trap is not present (revised 06/IS/97) Pay• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 Fiddlers Circle .West HYanni sport,Mass. Owner: Elaine Tung Dale of Inspection: 8/1 7/9 8 TIGHT OR HOLDING TANK:Akdy,(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grader Material of construction:L/QconcreteAometal Fiberglass f�iPolyethyleneiQgother(explain) A> Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: AM Alarm in working orde4AI Yes;)U& No Date of previous pumping: AM Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holdinq tanks are not present. DISTRIBUTION BOX:_NONE (locate on site plan) Depth of liquid level above outlet (nven: f� Comments: (note if level and distribution is equal, evidence of solids carryove(, evidence of leakage into or,out of box, etc.) _trihu -in hnx is not nrPsen PUMP CHAMBER:_42ove— (locate on site plan) Pumps in working order: (Yes or No) ZIA Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appunenances, etc.) Pump chamber is not present (r•vl�•d 0�/2s/17) ?.go 7 of 10 1 1n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. Owner: Elaine Tung Date of Inspection: 8/1 7/9 8 SOIL ABSORPTION SYSTEM (SAS):2 (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: d leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:, Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) .No signs of hydraulic- or pon inq A veaetation is normal --- CESSPOOL@ (locate on site plan) Number and configuration: Depth-top of liquid to inlet Inv n: Depth of solids layer: Depth of scum layer: 4 Dimensions of cesspool: Materials of construction: ZZ Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Di not pump inflow cesspoo Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) -lioamy sand to boney medium sand•No signs of hydraulic failure or ponding: All vegetation is normal. PRIVY:A44t, (locate on site plan) Materials of construction: NA Dimensions: NA Depth of solids: NA Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy -is not present (rovlsed 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. O..nes: ELaine Tung Dale or Inspection: 8/1 7/9 8 SKETCH Of SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (locate where public water supplY comes into house) o � Vo k -0 of 10 SUBSURFACE SEWAGE DISP";: ,l. SYSTEM INSPECTION FORM 1, T C SYSTEM INFOh',1 .TION (continued) Property Address: 2 Fiddlers Circle West Hyanni sport,Mass. Owner: Elaine Tung Date of Inspection: 8/1 7/9 8 Depth to Groundwater I b Feet Please indicate all the methods used to determine High Groundwater Eslwation: Obtained from Design Plans on record Observation of Site (Abutting grope bservation hole, basemtrth sump etc.) f�Determine it from local conditions Check with local Board of health Check FEMA Maps CCheck pumping records y Check local excavators, installers Use USGS Data Describe in your own words how you established the High Ground./,rerElevation, (Musi be completed) Used water contours Map. Gahrety & Miller Model 12/16/94 (swl..d 04/1S/17) . P.y.•,'1QOf 10 a•nwn a•..-n T�a�tT awrnw•nrrwrraan r�.tnnaanw+w�r+�nww.n nR.aa 1A'wT011aP' .rr.-�-.-.ti�ar.-..�.. TOWN OF Barnstable BOARD OF IIEALT11 1 SUIISURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION n-•Tay-7••.-:: -7. n^.rr►tJnmw•n.Tri r�T/I�' aw•wrrn'-7�nVaR�.nrwr-`P�+�aTam•�*r�'w7 s�.nn•1r*ar+.nT�•+rrn..r.�.•.-v-rr•a+-1 -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 2 Fiddlers Circle West�Hyannisport, Mass . ASSESSORS MAP , DLOCK AND PARCEL # o OWNER' s NAME ELaine Tung PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. . COMPANY NAME J-P.Macomber & Son Inc-:` COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Tovn or City Stag ter ' COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 - 1 578 w , CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system , 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 or site sewage disposal systems . Check e : Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or .tfhe environment as defined in 310 CMR 16 . 303 . Any failtire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED# r The inspection which I have �concted has found that the system fails t Protect the })ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection f rm . Inspector Signature Date Zl a marsaarsru ancm�mr One copy of this certification must be provided to the OWNER, the DUYER where applioable ) and the I3QARD OF IIIEAVilI. + If the inspection FAILED, th'e owner or operator shall upgrade ' the eye tem within o'ne year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CHR 16 . 306 . partd .doc ' (0 5C, W (n ZJ ti THE COMMONWEALTH "OF M.ASSACHUSETTS t DEPARTMENT OF ENVIRONMENTAL 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 CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. hmc x, 1995 ncimy, Dircclur of tlic l) i lull of Watcr Pollution Control A-C;E-P-ERMITU_0.;7\j-1 r-L --- - - = � - - - — 5-U 1-L-D-E R 5—tJ-lam - A=LE-P-E--R-"- --17 v5-suED — 1� - D-A-X-E—C.O N_l n. 3 r V ._ r No,.ar_ /_ Fns.... ...;........._ THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALT Appliration for Uhipmal Workii Towitrurtion Pprnift Application is hereby made for a Permit to Co s uct ( ) or Repair ( an Individual Sewage Disposal 5--- P - _ ............ ...•---•----. ._.... ---------- --- --------- •.... ..-• .----•--•-----••----••----------•------•-•--••--.---•••---------••-------................. n-Addres or Lot No. . -• . . • . . .............. Owner --•------------•----------------•---•--------Address p Instal r Address UType of Buildin Size Lot----------------------------Sq. feet Dwelling o. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _-____-..-________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ... ------------------------------••--------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow--_-_-___.___--__-_- _____.._---.-_.gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width----.----------- Diameter----------.----- y)th......._-.-.._ xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------- _______.-sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area-.--.____-.-.._...sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------- ----------------•----------------------------•-------•-------- Date-------------------------- ------- Test Pit No. 1..._------------minutes per inch Depth of Test Pit_------------------ Depth to ground water...--_--..__.._.__.____. (� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ ------------- -------------------------------------------------------------------------------- •------ ---- •---------------------------------------------------- 0 Description of Soil------------------------------------------------------------------------------------------------------------------------------------------ ---------------- x x -------------- ------ ------------------------------------------------------------------------------- -------------- •-•----- - --->--- U Nature of Repairs or Alteratio A7nser when a ic � -------._.. ---------------------------- -------- - ------- ------------•--- -. --_------------- Agreement: , The undersigned agrees to install the aforedescr, Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Co he unders' ed fur ier Oes of to place the system in operation until a Certificate of Compliance has been s e boa f heahl .... - - Application Approved By....... �/ Y -------- --7Lf �� t Application.Disapproved for the following reasons-................................... -•-------------------------------------------------------------- -------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------ Date PermitNo......................................................... I Issued........................................................ Date No.__1i Al• .. Fps..:. .. . THE COMMONWEALTH OF MASSACHUSETTS s +" BOARD O HEALT' r . .OF...... . .. ..... . .. ' Appliration -fur :41BVoiial Vorkii C onfitrurtion Vrm t Application is hereby m de for Permit to Cons uct ( ) or Repair ( an Individual Sewage Disposal sy r ............ ------------ --------- -• -• -•--• ••---•.. ---- --.. ..........---•-••--•--•••..•-------....-------------••--•--•-----------------••--...---•-- .-A ddres or Lot No. Owner Address Lra ........ .. _ ..... _ p Install r Address d Type of Building Size Lot----------------------------Sq. feet U Dwelling o. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) PL4 Other Type of Building __........................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a 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. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------............Sq. it. Z Other Distribution box ( ) Dosing.tank ( ) . aPercolation Test Results Performed by--------------------------------------- ---------------------------------- Date------------------------------------ Test Pit No. 1----------------minutes per inch- Depth of Test Pit.................... Depth to ground water-.-------------------- G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water__-...._.:___________--- a --------------------------------------------------`--------------------------------••----•---- -------------------------------•------------------------- 0 Description of Soil------------------------------------------•---•-•-•-----•--<--- ---•--••-----------------•----.._...----------•------••----._..._.........------------...-------------- x ---=- ---- --------- --- Z ------------------------------------------------------ ,� __------------------------------ � { IAW V Nature of Repairs or Alterations Anss er when a icable- :- ....__:. f!t,- r __---.__ _ ____ ________ _- ---------- i.C. ..... + Agreement: The undersigned agrees to install the aforeclescfjkn Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Co he unders• ed fur ler es of to place the system in operation until a Certificate of Compliance has been s u e boa f healt igned._ ate Application Approved BY ••.... . r u ��' • 1010 w; Application Disapproved for the following reasons------------------------------------ --------------------------___----------------------------------- _________________________________________________________________________________________________________.._.__.__._._...____._______.._______-_________________....._._._......______...._...__._......_ ..t Date + Permit No......................................................... Issued............................................ f Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 1............ .OF.... .... ... .. .it... Trrtifirate of Tompliaurr , T S TO . RTIFY, That the Individual Sewage Disposal System. constructed or Repaired or bY" --- . ••• • ••-•------•---- --••---- -- --------------•--•---• ------ - .................. Installer at :. -• .............. ... �" y'i ---!----------------- has been installed in accordance with the provisions�tf icle XI of The State Sanitary Code as des ribed in the "+ application for Disposal Works Construction Permit No---------+2_-__:7:G! - dated--- 014 F THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONST D AS• GU NTEE THAT THE- SYSTEM WL L UN TION SATISFACTORY. DATE -(� --•----------------••------_ ----------- Inspector �A.� � �� = � �. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH D...�fJ.... ►�....OF....... .. No...; FEF4 652tPermission is hereb' grant d-'=`` -- - ----- ." to Const�t ) or ep it anydividu ewa D sal System , . Street as shown on the application for,Disposal Works Construction �it N =___... __._ _ Dated_- ..✓x _ ............ l - ..... ........ �4 Boar of Health L'r, DATE--- �--. ....- --`.�----------------„------f-.._.._.::_. - FORM 12$ HOBBS & WARREN••I'N.C7�".'.PUBLISH 4 �t