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HomeMy WebLinkAbout0006 LINDA LANE - Health 6 LINDA LN. ,HYANNIS A .= 248 060 0 0 0 COM1140NIN-EALT11 OF MASSACHUSEI'' 'IS EXECUTIVE OFFICE OF ENVIRONMENTAL AF FAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION TITTLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 6 Linda Lane Hyannis Owner's Name:Owner's Address: Susan Carr 1 19 'R echwood Hills Datc of Inspection:_ 1�t rQ 1 2 3 608 Name of Inspector: (please print)_ Sean Jones Company Name: William E. Robinson Septic Service 1llailingAddress: P O_Box 10n9 Centerville MA Telephone Number. , 77S-13776 CERTIFICATION STATEMENT 1 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 uispection was performed based on my training and experience in the proper functionand maintenance of on site sewage disposal systems. 1 am a DEI' approved system inspector pursuant ,tooSS Won 15.340 of Title 5(310 CPI1t 15.00o). 1-he system: t'asses Conditionally Passes Needs F valuation by the Local Approving Authority Fails Inspector's Signature: Date: (p a� //gip �T The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health-or DEI)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 tic buyer,if applicable,and the approving; authority. Notes and Conuncnts "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 (he future under(lie same or different conditions of use: Tidc 5 Inspection Form 6/15/2000 page I f Page 2 of OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUItFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 6 Linda Lane Hyannis Owner: Susan Carr Date of inspection: -T Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D f A. Sys m Passes: 71 have,not found any information which indicates that any of the failure criteria described in 310 CMIt 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. t Comments: } I B. System Conditionally Passes: NIA 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 c4ltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a compl)ing 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 Idgh static water level in the distribution box due to broken or obstructed pipes)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)arc replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 tunes a year due to bmkcn or obstit ctcd pipe(s).The systcnn will lass inspection if(with approval of the Board of licalth): broken pipes)arc replaced obstruction is nanoved ND explain: Page 3 of OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 6 Linda Lane Hyannis Owner: Susan Carr Date of Inspection: C. Further Evaluation is Required by the Board of Ilealth: 14,11A Conditions exist which require further evaluation by the Board of Healdt 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.delerntines in accordance with 310 Chill 15.303(I)(b)that the system is not functioning in a manner which will protect public health,safety and the environtnenl: ' _ 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. Systcm will fail unless(lie Board of 11e2101(and Public Water Supplier,if any)determines that the system is functioning in a manner(hat 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 I 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 I we ll. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more froul a private water supply well*• Method used to determine distance 'This system passes if the Kell water analysis,performed at a DEP certified laboratory, for coliforn bacteria and volatile organic compounds indicates that the well is free hot]'pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided Qtat no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. O(her: y 3 1'agc 4 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSUIVACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 6 Linda Lane Hyannis Owner: Susan Carr Dale of Inspection: (Q aI aOt�f� D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for ant inspections: Yes No/ _ V 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 _ J Liquid depth in cesspool is less than G'below invert or available volume is less than',day flow Required pwnping more than 4 times ur the last year NOT due to clogged or obstructed pipe(s). Numbci oftinnes pumped_. Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is witlrun I00.feet of a surface water supply or tributary to a surface / walcr supply. Any portion of a cesspool or privy is within a Zone I of a public well. fAny 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 w•atcr supply well with no acceptable wvater quality analysis. (This system passes if the well water analysis, performed at a DEP cerlified laboratory,for coliform bacteria and volatile organic compounds indicates drat llre Nell is free from pollution from (hat facility and (he presence of ammonia nitrogen and nitrate nitrogen is equal (o or less than 5 ppm, provided Thal no other failure criteria arc triggered.A copy of the analysis must be attached to (his form.] NJ (Ycs/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 tine Board of health to determine what will be necessary to correct the failure. E. Large Systems: ^/ To be considered a large sy em the systenn must sern•e 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 Iullowing: (Tlre following criteria apply to large systems in addition to die criteria above) yes no _ tltc system is within 400 feet of a surface drunkung water supply tlrc system is within 200 feet of a bibutary to a surface drinking water supply the system is located un a nitrogen sensitive area(Interim Wellhead Prolection Area—IWI'A)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section C the systun is crxuidered a sig nif Lmit threat,or answered "yes" in Section D above the large system lras faikd.Zlre vwn:r cr operator of airy large system considered a significant ducat under Section E or failed under Section D shall upgrade the system in aceordarue with 310 CNIR 15.304.The systcnn ow,rcr should contact the appropriate regional oflicc of the Dcpaitnncnt. 4 Page S of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 6 Linda Lane Hyannis Owner: an Carr Dale of Inspectloo: vo 6 Check if the following have been done.You must indicate' es"or .no,,as to each of the followin Yes No/ ✓ Pumping information was provided by the owner,occupant,or Board of Health V ere any of the system components pumped out in the previous two weeks 7 ;. Has the system received normal flows in the rev' o previous two wee / P k period . ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? x/ P 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 7 Was the site inspected for signs of break out? Were all system components,excluding the SAS, located on site 7 ✓ _ Were the septic tank maidioles 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 7 v Was the facility owner(and occupants if different from o%kiier)provided with information on the maintenance of subsurface sewage disposal systems? proper The size and location of the Soil Absorption System(SAS)on the site tras been determined based on: Ycs no / Existing information. [:or 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 disce ' is unacceptable)(310 CMR 15.302(3)(b)] PP tan 5 Page 6 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 6 Linda Lane Hyannis Owner: Susan Carr Date of Inspection: r 7,901Z FLOW CONDITIONS RESIDENTIAL 3 Number of bedrooms(design): Number of bedrooms(actual): 33C� P.p DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): Number of current residents: C� Does residence have a garbage grinder(yes or no): tit D Is laundry on a separate sewage system(yes or no):AID [if ycs separate inspection required] Laundry system inspected(yes or no): A Seasonal use:(yes or no):AO Water meter readings, if available(last 2 years usage(gpd)): 2005 — 40, 000 Sump pump(yes or no): ND 20 — 78, 000 Last date of occupancy: CONINIERCIAL/INDUSTRIAL Af JA, Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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 INFOIOIATION Pumping Records Source of information: Atw Sfjfc.-- ae>oo Was system pumped as part of the inspection(yes or no): /oil If yes,volume pumped: gallons-- How was quantity pumped detenuined? Reason for pumping: _Y IE 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 ally) _lnnovative/Alternative tecluiology.Attach a copy of the current operation and maintenance contract(to be obtained from system owvncr) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: C�o C>O Were sewage odors detected when arriving at the site(yes or no):J►�e� • Vgc ,ofI OFFICIAL INSPECTION FORM —NOT I'OI( VOLUN-['AI(Y ASSLSSNILN7'S SUBSURFACE' SL;IVAGE DISPOSAL S1'Sj'1;111 INS11FICI'ION F0101 PAIIT C SYSTEM INFORMATION(cuntuwcd) Pruperly Address: 6 Linda Lane Hyannis Olvncr: Susan Carr Wit ofof Inspection: BUILDING SMEII(locale un silt plan) Dcpdt below grade: C9 r f/^ Materials of construction:__-_casl iron J4U PVC_oilier(explain). Distance frunl private water supply well or suction line: _ Curnmcnls(oil condition of joints,vcnling,evidence of leakage,cic.): SLPTIC TANK:✓(locate on site plan) -4 Depth below grade: rb/c Material of eonslruuiun: V CVrlcrclt mclal fiberglass I)ul)Cdlylcne _vlhcr(explain) — — — If rail,at cj metal list certificate) age: _ Is age cvnl}rlrle�by a CerliGcate 0 Compliance (yes or no): —(attach a cull ul Dimensions: Sludge depth. Dlslance from lop of sludge to bultulli Scum Illicl,rlcss: I it of uullct Ice or Wilk: 3 ` _ Distance from Iup urscum lu top of uullct Ice or balllc: _(n r` Distance boll)buttunl of scum to bollum of uullct ee ur balllc: 3 el Ilua acre dimcnsiuns dcicnnincd. OPe4ed irO✓crf 4/ Conuncros(oil pumping rcconuntnJations. inlcl and uullct tcc or balllc cur— r , sUl u al ii c6r�VIC-4+T Ir�cl; as elated to oullcl ulvell,evidence of leakage,etc.): ink o04-1c f- n e C cA t-b I-v G� •,� IC dC ✓I r71- 5 C l c,,. fit i `�-�L�3 "�w - J — GREASE TI1A1':l� (Ivcatc on site plan) Depth below grade:_ Material : eoruUudiun:—ton(rcic 1Sllctal lberglass_pul)•cill)•Icnc olhcr Dimensions: ----- -- Scum thickness. Distance (role lop of scum to top of uullct Ice or balllc: Distance from button,of stun,to bvllonl of uuticl Ice or balllc: Dale of last pumping: ---— CUI1lmcllts(oil pulllpmg Icc0111111clldal,Ulr" inlcl and uullct tcc or bafllc cum.l,tlr":t, slludmal 1111cp1q, byutd Icvcl; a; related lu oullct invcll,cs idcncc of Icahag,c, 7 Page 8 of OFFICIAL INSPECTION 1�0101 — NOT FOR VOLUNTARY ASASSNIL M'S SUBSURFACE SLWAGI: DISPOSAL SYST11, n1 INSPF.CI'ION FORM PART C SYSTEM INF0101ATION(continued) Properly Address: 6 Linda Lane. Hyannis i s Owner: Dole of Inspection: oG� TIGHT or IIOLUING TANK: _(tank nwst be puny,cJ at lime of inspection)(lucate on site plan) Ueplh below grade: Material of construction:__cuncrele_metal _fiberglass _ polycillylene othcl(explaill): IJimussions: Capacity: gallons Ucsign flow; --gallons/day Alain present()'es or no): Aluns Icvd: Alain in working ordcr (�cs ur nv): Date of last pumputg: Cununcnts(condition of alarm and fluat switches,cl(.). DISTRIBUTION BOX:Z(if ,l resent must be apcncJ)(Iocatc on site plan) Depth of liquid level above outlet invclt: 0 „ a c r,inw ur out of box,uc.). ny lid ts(Hole if box is Revel and Jislributiou Icaka,, lv outlets equal, a evidence or so carryover, any evidence of Ita66•� a. PUMP CUAMBLIl:LII�klocale on site plan) Pumps in caulking ordcr(),cs or nu). _ Alarms in working ordcr().es or no): _ Comments(note condition of pump chanrbcl,cunJrlirul of pump; and allpuricnanccs, ctc.) !'age 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Linda Lane yann 1 ss Owner: Susan Carr Date or lospeclion:_ �o�a f a d SOIL ABSORPTION SYSTEM (SAS): 61ocate on site plan,excavation not required) If SAS not located explain why: Type caching pits;number:_ ` leaching chambers,number: r leaching galleries,number:_ IcaAing trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: _ innovative/allemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic etc.): failure, level of ponding, Sol/ damp soil, condition of vegeta(ion, �.-4� � r` � 'u nio o�td wake- �� SA-s : co"w ow� 3a ,. wa. ©� CESSPOOLS:-/—vl4cesspool must be pumped as part of inspection)(locale 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): Continents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIM':N(� '(locale on site plan) Materials of construction: Dimensions: Depth of solids: Contitents(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 11agc 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Linda Lane Hyannis Owner: Susan Carr Date of Inspection: a pp 6 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. i Q 0 0 o 3 a Tf,N � a 3 V'ci SAS A-3 Page l l of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 6 Linda"!Lane _ Hyannis Owncr. S1an Carr - Date of Inspection: (�T/�doDk SITE EXAM Slope Surface water Check cellar Shallow wells y Estimated depth to ground water J+ 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: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: wo- J-- - I -- s es+z/'1 shed GJa HC4ESSI�9 !U A a� tt r STANDARD FORM From the Office of: PURCHASE AND SALE AGREEMENT BK Real Estate, Inc. 1645 Route 28 Bayberry Square 1B Centerville, MA 02632 This First day of April 2002 1. PARTIES James V. and Geraldine M. Finn AND MAILING 6 Linda Lane, Hyannis, MA 02601 ADDRESSES hereinafter called the SELLER, agrees to SELL and (rill in) nominee, 129 Moore aElliottt Rd. ,nd Gardiner WCenterrville,1dMA102632y, or their hereinafter called the BUYER or PURCHASER,agrees to BUY, upon the terms hereinafter set forth, the following described premises: Land with building thereon located at 2. DESCRIPTION 6 Linda Lane. , Barnstable (Hyannis) , MA; being more (rill in and include a particularly ttheBarns describe tableCountynRegist De rryooflDeeds1921 Page 128 recorded title reference) 3. BUILDINGS, Included in the sale as a part of said premises are the buildings,structures,and improvements now STRUCTURES, thereon, and the fixtures belonging to the SELLER and used in connection therewith including, if IMPROVEMENTS, any, all wall-to-wall carpeting, drapery rods, automatic garage door openers,venetian blinds, FIXTURES window shades, screens, screen doors, storm windows and doors,awnings,shutters,furnaces, heaters, heating equipment, stoves, ranges, oil and gas burners and fixtures appurtenant thereto, (fill in or delete) hot water heaters, plumbing and bathroom fixtures,garbage disposers,electric and other lighting fixtures, mantels, outside television antennas, fences, gates, trees, shrubs, plants,and, j&WkX:jF XXK 0510-40ua 1W air conditioning equipment, ventilators, dishwashers,wArA0WXMMW= aaxlKitym; and refrigerator, window blinds, and kitchen stools. but excluding 4. TITLE DEED Said premises are to be conveyed by a good and sufficient quitclaim deed running to the BUYER, (fill in) or to the nominee designated by the BUYER by written notice to the SELLER at least seven ' Include here by specific days before the deed is to be delivered as herein provided,and said deed shall reference any restric- convey a good and clear record and marketable title thereto,free from encumbrances,except tions, easements, rights (a) Provisions of existing building and zoning laws; and obligations in party (b) Existing rights and obligations in party walls which are not the subject of written agreement; walls not included in(b), (c) Such taxes for the then current year as are not due and payable on the date of the delivery of leases, municipal and such deed; other liens, other encum (d) Any liens for municipal betterments assessed after the date of this agreement; brances, and make pro- (e) Easements, restrictions and reservations of record, if any, so long as the same do not pro- vision to protect (� hibit or materially interfere with the current use of said premises; SELLER against BUYER's " breach of SELLER's covenants in leases, where necessary. 5. PLANS If said deed refers to a plan necessary to be recorded therewith the SELLER shall deliver such plan with the deed in form adequate for recording or registration. 6. REGISTERED In addition to the foregoing, if the title to said premises is registered, said deed shall be in form TITLE sufficient to entitle the BUYER to a Certificate of Title of said premises,and the SELLER shall deliver with said deed all instruments, if any, necessary to enable the BUYER to obtain such Certificate of Title. 7. PURCHASE PRICE The agreed purchase price for said premises is -------$313, 000.00--------- (rill in); space is Three Hundred thirteen Thousand and allloweed to write out dollars, of which the amounts if $ 3 0, 0 0 0.0 0 have been paid as a deposit this day and desired $ $ 2 8 2,0 0 0.0 0 are to be paid at the time of delivery of the deed in cash,or by certified, cashier's,treasurer's or bank check(s). $ 1, 000. 00 as binder to offer 03/15/02 $ 313, 000.00 TOTAL COPYRIGHT©1979, 1984, 1986, 1987, 1988,1991 All rights reserved. This form may not be copied or reproduced in whole GREATER BOSTON REAL ESTATE BOARD 1121' or in part in any manner whatsoever without the prior express written EGUAL HOUSING Rev. 1999 Form No.RA151 OPPORTUNITY consent of the Greater Boston Real Estate Board. CWV 5.0 This instrument,executed in multiple counterparts,is to be construed as a Massachusetts contract,is to take effect as a sealed instrument,sets forth the entire contract between the parties, is binding upon and enures to the benefit of the parties hereto and their respective heirs,devisees,executors, administrators,successors and assigns,and may be cancelled, modified or amended only by a written r instrument executed by both the SELLER and the BUYER. If two or more persons are named herein as BUYER their obligations hereunder shall be joint and several. The captions and marginal notes are used only as a matter of convenience and are not to be considered a part of this agreement or to be used in determining the intent of the parties to it. LEAD PAINT The parties acknowledge that,under Massachusetts law,whenever a child or children under six years LAW of age resides in any residential premises in which any paint, plaster or other accessible material contains dangerous levels of lead,the owner of said premises must remove or cover said paint,plaster or other material so as to make it inaccessible to children under six years of age. 29. SMOKE The SELLER shall,at the time of the delivery of the deed,deliver a certificate from the fire department DETECTORS of the city or town in which said premises are located stating that said premises have been equipped with approved smoke detectors in conformity with applicable law. 30. ADDITIONAL The initialed riders, if any,attached hereto,are incorporated herein by reference. PROVISIONS 1. See attached Contingency Addendum and Property Transfer Notification Certification. FOR RESIDENTIAL PROPERTY CONSTRUCTED PRIOR TO 1978, BUYER MUST ALSO HAVE SIGNED LEAD PAINT"PROPERTY TRANSFER NOTIFICATION CERTIFICATION" NOTICE: This is a legal document that creates binding obligations. If not understood,consult an attorney. SELLER(or spouse) Geraldine M. Finn SELLEOR James V. Finn Taxpayer ID/ Taxpayer ID/ a BUYER We y Moore BUYER Gardiner W. Bridge B9 Real Estate, Inc. Broker(s) Cotton Real Estate Copyright© 1979,1984,1986,1987,1988,1991 Greater Boston Real Estate Board. All rights reserved. Page 4 TOWN OF BARNSTABLE LOCATION 6 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT! D INSTALLER'S NAME&PHONE No SEPTIC TANK CAPACITY LEACHING FACIL=: (type) �'�7 -`� L- (size) NO.OF BEDROOMS 3 BUILDER OR OWNER A� A— PERMITDATE: --: -3—_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 . ` urntshed y feet of leaching Feet within 300 facility) F b . . .. ... ..... i I C ; i - I ' 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) Y William E . Robinson,S,zhereby certify that the application for disposal works construction permit signed by me dated 2 concerning the property located at 6 T Anda T a n P�, lilra n n i s T� meets all of the t following criteria: o The failed system is connect d to a residential dwelling only. There are no commercial or business uses associated with the d !ling. The soil is classified as' LASS I and the percolation rate is less than or equal to 5 minutes per inch. J There are no wetlands within 100 feet of the proposed septic system There are no pnvate wells within 150 feet of the proposed septic system There is no inc ease in flow and/or change in use proposed O There are n variances requested or needed. Y The bottofn of the proposed leaching facility will not be located less than five feet above the groundwater table using the Frim for groundwater table elevation. (Adjust the g P maxim adjusted gr ( l � methofl when applicable] If ,eS.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed I .ching facility will not be located less than fourteen(14) feet above the maximum adjusted roundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) J - B) G.W. Elevation +the MAX. High G.W. Adjustment . = 26 . b DIFFERENCE BETWEEN A and B 3 SIGNED : �"'r DATE: Zo` [Sketch proposed plan of system on back]. q:health folder:cent E^ .\ ^ .. . l<"``� �✓ -' e / � 1 V �,:�. �� o a f! ''� e . � �_ V l "---_ . ` `/�__ �/1 6 1� i �1 i _, t i TOWN,OF BARNSTAB_LE LOCATION oe-#�'�, G. A SEWAGE VILLAGE 04SSESSOR'S MAP & LOT r o INSTALLER'S NAME&PHONE NO. 6 .t.S 6 SEPTIC TANK CAPACITY A<6—n LEACHING FACILITY: (type) �'" '�i a—`�' 4—C (size) NO.OF BEDROOMS 3 BUILDER OR OWNER MW 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 within 300 feet of leaching facility) Feet Furnished by 'r ����� • , •' n" I `f ^. �.���t I ,.< �_ _� �� � i i I --�. _..� .. .. i .� 1 �1 i �_ �I v�Qt� g S�r / No. i, Fee $50- —' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS appuration for Migoal 6votem Con!aructian Permit Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 6 Linda Lane , Hyannis, NIA Jim Finn Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) New Title-5 septic system consisting of a tank, D-box and 2 leach chambers with stone all around.. 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 Certifi- cate of Compliance has been isssued'by thisBoard of Hea Signed Date 7 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued - Fee 0 En erect in computer:. - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS a = ZippYication for ]Digpogar 6pgtem (Congtruction permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 6 Linda Lane, Hyannis, MA Jim Finn + Assessor's Map�el Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 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 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) New Title-5 Septic system consisting of a tank, D-box and 2 leach chambers with stone all around.. Date last inspected: t 'f 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 ad`d not to place the system in operation until a Certifi- cate of Compliance has been issu'd b th' �/�2a!rd'of Heal t fp Signed � / ti. .. '` Date Application Approved by Date Application Disapproved for the following reasons 6 1 Permit No. Date Issued --------------------------------=------ THE COMMONWEALTH OF MASSACHUSETTS Finn BARNSTABLE, MASSACHUSETTS (Certificate of (tompliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Aband ned( by Wm. E. Robinson Septic Service at Linda Lane, Hyannis c has been constructed in accordance with the provisions f Title 5 and the for D� osal System Construction Permit No. dated Installer tn�m. RobPson P• Designer The issuance of this pegs s all be construed as a guarantee that the sys a function a fdesign�e, . Date l�l )/) Inspector ��� V�I��i �/� � - --------------------------------------- No. � / — O o ( Fee $5 0 7Z c f 1--0P0 THE COMMONWEALTH OF MASSACHUSETTS Finn PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS M googar OpMem (Congtruction Permit Permission is hereby ranked to Construct( )Repair fX )Upgrade( )Abandon( ) System located at bg Linda Lane, Hyannis f'2 . 7 6 � and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/h rr duty rto comply with Title 5 and the following local provisions or special conditions. Provided: Construction must•:bee completed within three years of the date of this permit. Date: Z 3 /�/ Approved by _ off° 0 ATE: .9 V.4/98 PROPERTY ADDRESS: Lindzf- Lane a��a Hyannis,Mass. L 02601 1998 TOwN y '0LT1j0EPr"8LE On the above date, I inspected the "ptic system at the a` This system consists of the following: 1 . 1 -6 'x8 ' block cesspool : . Based bn my Insck+ctlon, I certify the following condltlons: 2 . This is not' a title five septic system.This i.s a sewage system. 3 . The present cesspool is operrational. 4 .. The sewage system is .to small to handle• a 3 bedrrom home. 5 . The sytsem should be upgraded to a title five septic system. SIGNATURE: Name . J P . Racomber Jr... --------------- Company:—J• P_Macogber & Son`Inc , Address: Centerville ,,Mas�si_02b32 ` Phone: ` THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MAC MBER & SON, INC, 7inkt-C•upoolrl.eachtleIds . PUMp 4 InIt4II&d Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 77.5.333$ 775-6412 l \ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617.292.5500 r WILLIANI F.WELD TRUDY COXE Govcmor Sccrctarr ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioncr PART A Edward Kneale CERTIFICATION Executor Property Address: Linda Lane H annis Mass. 617 Main Street p rty y � Address of Owner: OSterville,Mass . Date of Inspection: 9/1 4/9 g (If different) 02655 Name of Inspector: i9s hber Jr. I am a DEP appro aif system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Inc. Mailing Address: Box 66 Centerville,Mass_ 02632 Telephone Number:5(118_7 7 S_3 31 R CERTIFICATION STATEMENT I cenify 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's SignatuPrshal'l;submit azkDate: The System Inspect 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 owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: %S 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: System is 31 years old. The sytem is to small to handle a three bedroom ho is _ Syst_Pm shout c3 ha upgradPr-1 f-n a f-i 1-1 a five septic system. 95 Code. BI 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. .V,4,04- 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; 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) Papa 1 of 10 DEP on the World Wide Web: http:Uwww.magnet.state.ma.us/dep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Properly Address: 2 Linda Lane Hyannis,Mass. owner: Estate Of John B. Whitman Oatc of Inspection: 9/1 4/98 B) SYSTEM CONDITIONALLY PASSES (continued) 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 pipes) are replaced obstruction is removed distribution box Is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed n FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ /-y Conditions exist which require further evaluation by the Board of Health in order to determine if the system is (ailing to protect the public health, safety and the environment. t) 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: 44 Cesspool or privy is within So feel of a surface water yp Cesspool or privy is within SO 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: The system has a septic tank and soil absorption system (LQ 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 W 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 SO feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than too feet but SO 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 egwl to or less than S ppm. Method used to determine distance d//i� (approximation not valid). )) OTHER of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2 Linda Lane Hyannis .Mass. Owner: Estate Of John B. Whitman Date of Inspection:9/1 4/9 8 D) SYSTEM FAILS: You must indicate ei;�.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 corTea 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. AAW le Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid Pi uid depth in cesspool 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 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 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 wrt no acceptable water quality analysis. If the well has been analyzed to be acceptable, anach 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, the system is within 400 feet of a surface drinking wafer 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) 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 04/2S/)7) P•y• 3 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Properly Address: 2 Linda Lane Hyannis,Mass. Owner: Estate Of John B. Whitman Date of Inspection:9/14/98 ' Check if the following have been done: You must indicate either 'Yes" or 'No" as to each of the following: Yes No,r ' Pumping information was provided by the owner, occupant, or Board of Health. 'e/ None of the system components have been pumped for at least two weeks and the system has been receiving normal now 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,04luding the Soil Absorption System, have been located on the site. _t/OkJe 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 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) (15.302(3)(b)) (r.vl..d 0{/13/37) Dip• { of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2 Linda Lane Hyannis,Mass. Owner: Estate Of John B. Whitman Date of Inspection: 9/1 4/98 FLOW CONDITIONS RESIDENTIAL: y Design (low: D .pj. Jbedroom for $.A.S. Number of bedrooms: ZD Number of current residents: Garbage grinder (yes or no): Laundry connected to system (yes or noQb Seasonal use (yes or no):Vb / Water meter readings, if available (last two (2) year usage (gpd): b 17� Sump Pump (yes or no): a/1 � )s Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: eAaallons/day Grease trap present: (yes or no)A24 Industrial Waste Holding Tank present: (yes or no),A Non-sanitary waste discharged to the Title 5 system: (yes or noy&' Water meter readings, if available: �If Last date of occupancy: OTHER: (Describe) , Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as pan of inspection: (yes or no)AP If yes, volume pumpedallons Reason for pumping: /V� /JLJil?� 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) ,019 VA Technology etc. Copy of up to date contract? Other „(JJ APPROXIMATE GE of all components, date installed (if known) and source of information: _ f 4"'PA- a e�r4'-Y'o>! Sewage odors detected when arriving at the site: (yes or no) (rwisod 04/25/M ?&go 5 of 10 SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:2 Linda Lane Hyahnis,Mass. Owner: Estate Of John B. Whitman Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: material of construction: cast iro 40 PVC_other (explain) or a--�w 0, , Distance from private ;valet supply well or suction line /0 fi Diameter 1,/ Comments: (condition of joints, venting, evidence of leakage, etc.) Joints appear tight No pvi dpnnim of i o@Iran System is vented throuah the hnllGp vent SEPTIC TANK: (locate on site plan) Depth below grade:,&( material of construct oconcrete<?dmetalgjAFiberglassA/APolyethylene /9bther(explain) If tank is metal, list age AZ Is age confirmed by Certificate of ComplianceAg&(Yes/No) Dimensions: 92A Sludge depth: lyly Distance from top of sludge to bottom of outlet tee or baffle:AW Scum thickness:�_ Distance from top of scum to top of outlet tee or baffle:W//01- Distance from bottom of scum to bottom of ou I tee or baffle: 141A;` How dimensions were determined: //VV 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 present. GREASE TRAP:A&Le_ (locate-on site plan) Depth below grade:, material of construction: oncrete /AmetaliU�Fiberglass,f&Polyethylene4Nother(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:1W Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: d2 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. (r•vl�•d 0�/35/97) Y•y• � of 10 � 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address: 2 Linda Lane Hyannis,Mass. Owner: Estate Of John B. Whitman Date of Inspection:9/1 4/98 TIGHT OR HOLDING TANK:�J�(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:VA Material of construction:l/Aconcrete OVA metal NAFiberglass,VAPolyethylene4,&other(explain) b Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in workingorder 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. • I DISTRIBUTION BOX:,'�)AAIG (locate on site plan) Depth of liquid level above outlet inven: /1/1# 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. a PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) ,4 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.vsa.e Pap• 7 of 10 • J�r.1 • 111\\\ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 Linda Lane Hyannis,Mass. Owner: Estate Of John B. Whitman Date of Inspection: 9/1 4/9 8 SOIL ABSORPTION SYSTEM (SAS):—Z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number leaching galleries, number: leaching trenches, number,length: leaching fields, number, dime Sion overflow cesspool, number: Alternative system: Name of Technology: Z Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) None o the above are present -- CESSPOOL,R'J� (locate on site plan) Number and configuration: Depth-top of liquid to inl invert: U 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) Did not pump inf 1 rw rPssj]nnL Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Loamy sand to medium coarse sand No signq of hzUHranli fail „rc or ponding-All yPgPt-a t i nn is nnrmal• PRIVY: Abve-. (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.) Privy is not present (r•via•C 04/25/37) p•y• B o1 10 s SUBSURFACE S(%YAGE OISPOSAI. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION fcontinucd) Prope/1y Addle": 2 Linda Lane Hyannis,Mass. O.nCf: Estate Of John Whitman OJte of Inspection: 9/1 4/98 SKETCH Of SEWAGE DISPOSAL SYSTEM: include ties 10 at least two permanent references landmarks or benchmarks locale all wells within 100' (Locale where public water svpply comes into house) � x9 o , -j . C rN A L ,9�e. G t y. lt.rt l.d Os/)S/111 3'�p• J or 10 SUBSURFACE SEWAGE DISPI:r�—L SYSTEM INSPECTION FORM C SYSTEM INFOR ., .PION (continued) Properly Address: 2—Linda Lane Hyannis,Mass. Owner: Estate Of John B. Whitman Date of Inspection: 9/1 4/98 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwatw Elevation: Obtained from Design Plans on record bservation of Site (Abusing prope observation hole, basemtN'sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps heck pumping records �eck local excavators, installers Use USGS Data Describe in your own words how you established the High Grouncx,crElevation. Must be completed) Used water contours map. Gahrety & Miller Model 1.2/16/94 Ql • M1 .r ' Rl.T TI�RtTT>—TT1T1t'�JIR'nTnT/l1rIT 1'n'fJ'R1fT1rItRIlTT'RTT TttT11L 11/i'RIVIIi'{1 •. •�� t •TTTT�'.RrST�..T-.I—•.l 'DOWN OF Barnstable BOARD OF HEALTH J SUI)SURFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I �_ F^•Tr'1^T••.•t:r—T.irf.^.-.rnme'.'rr1'R.TPt 1'OlrJfstfaT.RrT.'-.S'tnvrRs�srm�r•rT11T�s�Ai/C�R�s nmin .t.rrr•l+•1r+..^ •-TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS _2-Linda Lane Hyannis,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Estate Of Jbhn B. Whitman PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. . COMPANY NAME J.P.Macomber & 9eri Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or Clty State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 790 _ 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj 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 ne : S ste6 PASSED ED 7 The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public 11e.Rlt11 or the environment as defined in 310 CMR 15 , 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have �contcted has found that the system fails to protect the ilublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date s�.ram•—.arm-1 — �,� (,wheropy of this rt.ification must be provided to the OWNER, the BUYER applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner orrMoperator shall upgrade he avote within o'ne year of the date of the inspection , unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 . 305 . partd .doc S, W Ul Z1 P7 ti sSbyv • THE COMMONWEALTH OF MA.SSACHUSETTS ti DEPARTMENT OF E ONMENTAL PRO . ECTION 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. lunc 8. 1995 Acung Dimctor of tnc ton of Watcr Pollution Control a a