The URL can be used to link to this page

Home My WebLink About0036 GROUSE LANE - Health 36 GROUSE LANE, HYANNIS A=268 260 r t, TOWN OF BARNSTABLE L1 OCpATION GfOJS, IV SEWAGE # �V l— 13 _;,� Vll;�LAGE ASSESSOR'S &LOT Zh 7- 260 INSTALLER'S NAME&PHONE NO.. ad?_r C o,, 1 SEPTIC TANK CAPACITY .., LEACHING FACILITY: (type) t1414 (size) NO.OF BEDROOMS BUILDER OR OWNER ��COG PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: L um Adjusted Groundwater Table to the Bottom of Leaching Facility Feet e Water Suppiy Well and Leaching Facility (lf any wells exist site or within 200 feet of leaching facility) Feet of Weiland and Leaching Facility(If any wetlands exist hin 300 feet of leaching facility) Feet hed by aj o=QJ a o N `� TOWN OF BARNSTABLE LOCATION SEWAGE # �. VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist s on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 1�' �� ' J � r �� \\ f\ 1 - r: `� � � . �.� i . J � �/ � � � O ii � � .��J � r � M �\ � � t � ��_ :.: _ Oil TO WN•OF•SARNSTABLE ._ (O t LOCR�N. _SEWAGE:# V1ZLAGE �' `- ASSESSOR'SNAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC-TANK CAPACITY LEACHING FAcaxr : (type) AAAW1 (size) NO.OF BEDROOMS �VLED INSPECTION BUILDER OR OWNER 61VP PERMTTDATE: COMPLIANCE DATE: a Separation Distance Between the: � n 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) a Feet Edge of Wetland and A/C; ping Facili (1f any wetlands exist within 300 feet f facili . Feet Furnished by r 6s . r �I �,fl�0EQ5 (pT'#� TOWN OF BARNSTABLE LOCATION -,36j _ d(i SE I AT►5 SEWAGE # VILLAGE �/�►�f(�d 'j�Q(�7 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.' SEPTIC TANK CAPACITY A c- LEACHING FACILITY:(type) C size) a V NO. OF BEDROOMS Webh OR PUBLIC WATER BMMM-OR OWNER 91- DATE PERMIT ISSUED: - DATE COMPLIANCE ISSUED VARIANCE GRANTED: .Yes No -----�. ��-• - 1 . � c� �n, �� ;.,;�. ;\ f�� .`'�". " � o; Ll :'o A �. i� 4 �. ("� .. w� V�° p � �� -a� d � �� I, �� d'T1 � .� z � � - �I x .. -, ��- • . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �Dizpoor bp.5tem Cott5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(V<Abandon( ) El Complete System §q Individual Components Location Address or Lot No.��r-s,�C Owner's Name,Address and Tel.No. Assessor's Map/Parcel L to w��70 In a%Ydddrress,and Tedl C Designer's Name,Address and Tel.No. S Ic 1 Type of Building: Dwelling No.of Bedrooms �L Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3S'J gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank &D- Type of S.A.S. L4.C, Description of Soil f - 5)441LO Nature of Repairs or A terations(Answer when applicable) ST o cc,45C�7-. /,-,I CL �! � -W 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 En 'ronmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ar Signed, Date Date Application Approved by Date -a Application Disapproved for the following reasons Permit No. 7ev Date Issued R,7 TOWN OF BARNSTABLE V LOCA.nON 5��Vi SEWAGE VILLAGE 0YZX t -t ASSESSOR'S R LOT,?,6 260 INSTALLER'S NAME &PHONE NO_717CL, E ASSESSOR'S SEPTIC TANK CAPACITY P;;TA-A /0ae,, .-3J1A4 -4 LEACHING FACILITY: (type) (4,erf i.),-L JXA4 (size) WSJ )c';i, X V I NO. OF BEDRO MS BUILDER OR-OWNER' PERMITDATE: —COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 'Peet Private Water Supply Well and Leaching.FaciLity (If any wells exist. on site or within 200 feet of leaching facility) Feet: Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet' Furnished by 0 61 Fit No. �"" �Z ¢ �f I Fee '/— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Application for �Di!gpogar 6psstem (Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abr andon( ) ❑Complete System CKIndividual Components Location Address or Lot No. 79(o r Owner's Name,Address and Tel.No. Assessor's Map/Parcel Ins ells. am ddress,and Tel. Designer's Name,Address and Tel.No. 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 3L7 gallons per day. Calculated daily flow 35 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 12t_ S?' Type of S.A.S. JA,C_. Zjt� _-TY1•T'o(�_S Description of Soil Nature of Repairs or Alterations(Answer when applicable) 'To—S Ti4 t c,,K e \4-10— LTv 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 Env' onmental Code and not to place the system in operation until a Certifi- cate of Compliance has beejssue ar al-th:- Signed Date -6 Application Approved by Date -0 Application Disapproved for the following reasons Permit No. ZQ'D "Z Date Issued L1#6110 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,tat the On-sim. -Serwagp Disposal System Constructed( )Repaired( k )Upgraded Abandoned( )by 'fie G.or �1 C at 3 �' Ot !�-,E v t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi No. /- Z / dated Installer Designer The issuance of this permit ll not be construed'as a guarantee that the syste 'll fu s design 2i. Date s 0/ Inspector - ------.--.------------------------------.— _ . No. � 2 /, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS li!5pogar *pgtem (Son0truction Permit Permission is hereby granted to Construct( )Repair( Upgrade )Abandon( ) System located at 1F and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. r Date: y y Approved by L y.W 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) h _ hereby Tl r by certify that the application for disposal works construction permit signed by me dated � ' , concerning the property located at (S r meets all of the following criteria: 2Cc)i -ZCo 6 ✓• This failed system is connected to a residential dwelling Y � only. There are no commercial or business uses associated with the dwelling. • /Ihe soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system here are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed /There are no variances requested or-needed. 4he bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation.;[Adjust the groundwater table using the Frimptor method when as plicable] f� If the S.A.S.will be located with h 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted. groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation (using GIS information) 3( B) G.W. Elevation +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B I — SIGNED : A DATE: [Please Sketch prop pl of system on back]. 'NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert Wu1 1 r 1 kL DATE: 10/1.'4./98 PROPERTY ADDRESS:.•,36 G- oUse Lane West Hyannisport 'Mass. On the above date, I Inspected the septic system at the above address. This system conslsts of the following: 1 . 1 -1000 gallon septic Is 2 . 1 -1000 gallon Precast leaching pit. Based bn my Inso-actlon, I certify the following conditions: 3 . This is a title five septic system. '-("'7T Code ) ' 4 . The Septic system" is in. proper wdrkig order at the present time. 5 . Pumped the septic atnk at time of inspection. Heavy scum & solids layers were present. 81GNATUR7: I , Name J P.Macomber Jr_. i '. . --- ------- Company:_`. P_ -Maco.mber. & Son- 'Inc . , Address: " --Boac-bb------�---�-- Cente r v 1 1e �,Mes-ps_02b32 Phone: ' ------- ., I THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tankt-Csupools-Lsachflaid& . Pump+d 4 Installed Town Sewer Connoctlons P.O. Box 66' Centerville, MA 02632.0066 77.5-3338 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION • ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 ,r WILLIAM F.WELD TRUDY CO. Govcmor Sccrct ARGEO PAUL CELLUCCI DAVID B.STRU Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Cornmissio. PART A CERTIFICATION Property Address: 36 Grouse Lane W. Hyannisport Address of Owner: Date of Inspection:l 0/13/98 Mass. (If diHerent) 8 e� Name of Inspector: JoseAh P.Macomber Jr. I am a DEP aeeProved system inspector pursuant to Section 15.340 of Title S (310 CM 0) Company Name: J.P.Macomber & Son Inc. O Mailing Address: BOX 66 Centerville,Mass. 02632 C � ' Telephone Number: _ 7 5-3 3 3>3 T 'fO � �'D �+ i� CERTIFICATION STATEMENT19p,, I certify that I have personally inspected the sewage disposal system at this address and that the ation bef&6A is tree, ccurate and complete as of the time of inspection. The inspection was performed based on my training a xxperienc S proper f ion and maintenance of on-site sewage disposal systems. The system: ,,,Passes q; I _ Conditionally Passes Needs Further Evaluation By the Lo al Approving Authority _ Fails Inspector's Signature: Date: The System Inspecto shall 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 submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owne and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: 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: S Ak One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upor: 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. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of R Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank 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: http:Ih.vw.mapnet.state.ma.uydep Printed on Recyved Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propcny Address: 36 Grouse Lane West Hyannisport,Mass. Owners Earl A. Duesel Oate of inspections, 0/1 3/9 8 e) SYSTEM CONDITIONALLY PASSES (continued) /k&6 Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) 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 pipets) are replaced obstruction is removed distribution box Is levelled or replaced Ali 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) arc replaced obstruction Is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A)b_ Conditions exist which require funher evaluation by the Board of Health In order to determine if the system is (ailing to protect the public health, safety and the environment. 7) 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 ENVIRONMENTi Cesspool or privy is within 50 feet of a surface water &11) Cesspool or privy is within So feet of a bordering vegetated wetland or a salt marsh. 1) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THA; THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: /vb_k,"IR The system Ku 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. A1� The system has a septic tank and soil absorption system and the $AS 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 5 ppm. Method used to determine distance AJA (approximation not valid). 3) OTHER tr•vt664 04/2s/!7) 7.0• 3 o! 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:36 Grouse Lane West Hyanni sport,Mass. Owner. Earl A. Duesel Date of Inspection: 1 0/1 3/9 8 D) SYSTEM FAILS: You must indicate e(t%•er 'Yes' or 'No' as to each of the following: 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 correa the failure. Yes No Backup of sewage Into facility or system t;omponent 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. � � / l/ Liquid depth in co+cpeel is less than 6' below invert or available volume is less than 1/1 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped I-. � Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. 11/ 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 portion of a cesspool or privy is within 50 feel of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than SO 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 (or coiiform 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: T The system serves a facility with a design now 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 100 feet of a tributary to a surface drinking water supply / the system is located in a nitrogen sensitive area (Interim Wellhead Prote0ion 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 Depanment for funher information. trev1aod 0{/aS/11) ?ago 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropenyAddress: 36 Grouse Lane West Hyannisport,Mass. Owner: Earl A. Duesel Date of Inspection: 1 0/1 3/98 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 now. _ The site was inspected for signs of breakout. _ All system components,41t6uding 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 scvm. 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 / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. ✓/ _ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (r.vt..d 01/2s/77) 31.0. 1 of 10 I SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 36 Grouse Lane West Hyanni sport,Mass. Owner: Earl A. Duesel Date of Inspection: 1 0/1 3/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: 9W R.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: Garbage grinder (yes or no):_A& Laundry connected to system (yes or no): aJ Seasonal use (yes or no): S Water meter readings, if available (last two (2) year usage (gpd):/D4& —R-V7, Sump Pump (yes or no):_� Last date of occupancy: -� COMMERCIAUINDUSTRIAL: Type of establishment: NA Design flow: AM allons/day Grease trap present: (yes or no)�A Industrial Waste Holding Tank present: (yes or no) Ir/� Non-sanitary waste discharged to the Title 5 system: (yes or no)jV,4 Water meter readings, if availa le:__ Last date of occupancy: VA OTHER: (Describe) Last date of occupancy: iU GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) If yes, volume pumper allons Reason for pumping: ) �" TYPE O STEM Septic tan k/ristr bvSem-bex/soiI absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other IX APPROXIMATE 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) Fay• 5 of 10 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:36 Grouse Lane West Hyanni sport,Mass. Owner: Earl A, Duesel Date of Inspection: 1 0/1 3/9 8 BUILDING SEWER: (Locate on site plan) Depth below grade: /T Material of constructio • cast iro _40 PVC_ other (explain) ,,, m p Distance from water u ly ell or suction line Diameter /_ Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:) &V (locate on site plan) Depth below grader Material of construction: !!concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age il Is age confirmed by Certificate of Compliance/ (Yes/No) Dimensions: "Jrit)a 4)d"e'4 f Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: a Scum thickness: Distance from top of scum to top of outlet tee or baffle: 0 Distance from bottom of scum to botto of outle tee or baffle: How dimensions were determined: 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.) Pump the tank ever 2-3 ears •Inlet & outlet tees are in place;The sep is an is structura y sound: The septic tank shows no evidence of leakage. GREASE TRAP:A� (locate-on site plan) Depth below grader Material of construction concrete&/�meta I OLF i bergl as sf/lPolyethylene4other(explain) Dimensions: Scum thickness: 11)4 Distance from top of scum to top of outlet tee or baffler Distance from bottom of sum to bottom of outlet tee or baffle: A/ _ 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.) Grease trap is not present. (revised 04/25/97) Peg* 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 36 Grouse Lane West Hyanni sport,Mass. Owner: Earl A. Duesel Date of Inspection: 1 0/1 3/9 8 TIGHT OR HOLDING TANK:6&)e_ (Tank must be pumped prior to, or at time, of inspection) (Irate on site plan) Depth below grade: Material of constructioty concrete4g metaltiAFiberglassNAPolyethylene/aother(explain) ilR Dimensions: VA Capacity: gallons Design now: gallons/day Alarm level: Alarm in working order ,4 Yes;, No Date of previous pumping: _ Comments: (condition of inlet tee, condition of alarm and float switches, etc.) Tight or holding tanks are not present DISTRIBUTION BOX:A�s(c (locate on site plan) Depth of liquid level above outlet inven:�i� Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or\out of box, etc.) Distribution box is not present, PUMP CHAMBER:1g0— docile on site plan) Pumps in working order: (Yes or No)_a Alarms in working Order (Yes or No)- Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Pump chamber is not present. (r.vs..c os/13/s1) 1.y. 7 of 10 v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Earl A. Duesel Owner: 36 Grouse Lane West Hyannisport,Mass. Date of Inspection: 0/1 3/9 8 SOIL ABSORPTION SYSTEM (SAS):JGO�A�N (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: a 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.) Sand & gravel to fine c;anrl Mr) q i gn S of hTdraulie E;;i 1 e or ponrli ncl-Al 1 xrartaj-ati nn ig X}A fit��a CESSPOOLS: A!dvp- (locate on site plan) Number and configuration: 8 Depth4op of liquid to inlet invert: iV Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Cesspools are not present_ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspools are not present _ PRIVY: (locate on site plan) Materials of construction:_ Dimensions: .U.d Depth of solids: A2A Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Privy is not present tr.vs..d 04/Is/37) P.y. 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continvcd) properly Addretl: 36 Grouse Lane West* Hyannisport,Mass. O,.ner: Earl A. Duesel Date or Inspection: 1 0/1 3/9 8 SKnCH Of SEWAGE DISPOSAL SYSTEM: inclvde tics to at least two permanent references landmarks or benchmarks locate all wells within 100- lloca►e where public wale( svpplY comes into house) f t. r C tr..►..e o�n s/s�1 �.o. � of so SUBSURFACE SEWAGE DISPC;.-.l SYSTEM INSPECTION FORM T C SYSTEM INFORl.t .TION (continued) Property Address: 36 Grouse Lane West Hyannisport,Mass. Owner: Earl A. Duesel Date of Inspection? 0/13 9 8 I Depth to Groundwater 1!5r Feet Please indicate all the methods used to determine High Groundwater Oevadon: '/Obtained from Design Plans on record 11 Observation of Site (AN uning prope bservation hole, baserrvri*sump etc.) (/Determine it from local conditions Check with local Board of health Check FEM^Maps t Check pumping records , Check local excavators, installers Use USGS Data Describe in your own words how you established the.High Grourx-rcrElevation. (Mvst be completed) ' t Used water contours Map. Gahrety & Miller Model 1 2/1 6/94 le•vl�•d 01/JS/f7) D•y. ''Dol 10 •...nn.-nr�.�Tr-,snrww•nt.w,rnnl7+RrnRnse+Tn►rnl�.'rn'I rs�rwlu.�•�rt�nwT 'TOWN OF Barnstable BOARD OF HEALTH , ti_•t�T..._,.,-'."�'.�SUD UIIFACR 9FH�AGFTDISPOSALSY9TF,M IN�F�CTION FORM - PART D .- CEIZ't'IFICATIUN 1 .-TYPL OR PAINT CI.EAALY- PROPERTY INSPECTED STREET ADDRES$. 36 Grouse Lane West Hyaannisport,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # C, g O OWNER' s NAMEEarl A. Duesel PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Sopf 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 _ 1578 a 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 ti6e 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 ne ; • System PASSED , The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection wtlicll I have con cted has found that the system fails to protect the ptiblic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature f Date . �„ One copy of this certification must be provided to the OWNER, the BUYER ( Where applicable ) and the 130ARD OF ){EAL17I. * If the inspection VAI LED, .the owner or""operator shall u pg within one year of the date of the inspection, unless allowed dortrequiredm otherwise as provided in 3.10 CFIR 16 . 306 . partd .doc 3 W 7 !'7 S bIN 7� THE COMMONWEALTH OF MA.SSA.CHUSETTS 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 S 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. r,Gc� — lunc K. 199% nctmy. Direct(>r Of tlic I) i ion tit' watct Pollution control e