HomeMy WebLinkAbout0035 REGATTA DRIVE - Health 35 REGATTA DR., HYANNIS
A=252-51005 LOT 58
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CC
TOWN OF BARNSTABLE
L . ATION y; gPgai-ta t)ri vP SEWAGE # 4/1 5/03
WLLACE Hyannis,Mass. ASSESSOR'S MAP & LOT
2 STALLER'S NAME & PHONE NO. Joseph P.Macomber Jr.
SEPTIC TANK CAPACITY 1 900 gal 1 on tank_ Di -;tri b u ion box_
LEACHING FACILITY: (type) 2-500 gallon leach (size) 25 'X1 3 ' X2 '
ing chambers.
NO. OF BEDROOMS 3
BUILDER OR OWNER Thomas McCafferty
PERMIT DATE: COMPLIANCE DATE: 4/1 5/0 3
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 -f leachin fac' ) Feet
Furnished by ` -
\ 1
\1 a
� d
~ man COMMONWEALTH OF MASSACHUSETTSjWAWATLE
EXECUTIVE OFFICE OF ENVIRONMENT L AFFAIRS
1, MAY21 PM12: 08
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 35 Re atta Drive
Owner's Name: Patrick Demko
Owner's.Address: .
S o `S1 W7S
Date of Inspection: May 24, 2005
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49
Osterville,MA 02655-0049
Telephone Number: (508)862-9400
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Ne s Further Evaluation by the Local Approving Authority
Fa' s
Inspector's Signature: Date: May 26 2005
The system inspector shall'4ty of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Carmnents
****This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Regatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: MU 24, 2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please
explain.
s
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection'if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Regatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: May 24, 2005
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Reeatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: May 24, 2005
D. System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
Yes No
✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
✓ Liquid depth in cesspool is less than 6'below invert or available volume is less than day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped—
✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
✓ Any portion of a cesspool or privy is within a Zone 1 of a public well.
✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes,if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large System:
To be considered.a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 35 Regatta Drive
Centerville. MA
Owner: Patrick Demko
Date of Inspection: May 24, 2005
Check if the following have been done: You must indicate"yes"or"no"as to each of the following:
Yes No
✓ — Pumping information was provided by the owner,occupant,or Board of Health
✓ Were any of the system components pumped out in the previous two weeks?
✓ Has the system received normal flows in the previous two week period?
✓ Have large volumes of water been introduced to the system recently or as part of this inspection?
✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
✓ Was the facility or dwelling inspected for signs of sewage back up?
✓ Was the site inspected for signs of break out?
✓ _ Were all system components,excluding the SAS,located on site?
✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes No
✓ _ Existing information. For example,a plan at the Board of Health.
✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3)(b)].
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 35 Rezatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: May 24, 2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Unknown
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sqft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of informatio
n: Unavailable
Was system pumped as part of the inspection(yes or no): No
If yes,volume pumped: _gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
✓ Septic tank, distribution box, soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed in 1998-per as built card
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Regatta Drive
Centerville. MA
Owner: Patrick Denzko
Date of Inspection: May 24, 2005
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: _cast iron _40 PVC other(explain):
Distance from private water supply well or suction line_
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 12"
Material of construction: ✓ concrete _metal _fiberglass _polyethylene
_,other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of
certificate)
Dimensions: 1500 gal.
Sludge depth: 2"
'Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity;liquid levels
as related to outlet invert,evidence of leakage,etc.):
Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage
GREASE TRAP:. None (locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle'
Date of last pumping:
Commments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 ReQatta Drive
Centerville, MA
Owner: Patrick Demko
,Date of Inspection: Ma 24, 2005
TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: Even
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
The D-box was level and clean.
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
° Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Rezatta Drive
Centerville MA
Owner: Patrick Demko
Date of Inspection: Ma
v 24, 2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:
✓ leaching chambers,number: 2- 13'x 25'(per as built card)
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
The chmnbers were dry and clean. There did not appear to be an si ns o -;lure. The bottom to rade was 4.5'. The cover was
2"below trade.
CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: None (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Y
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: _ 35 Rezatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: ME 24, 2005
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.
� Q�k Flab
A 6
r �y so
a as sa-
. a 30
ns«
10
Page 11 of 11 '
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Regatta Drive
Centerville, MA
Owner: Patrick Demko
Date of Inspection: May 24, 2005
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 30+/- feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours snaps
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours maps the maps were showing approximately 30'+/-to ground water at this
site.
This report has been prepared and the system inspected and passed as of the date of inspection. This report is
not a warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report.
11
4
RECEIVED
DATE ; /5 4/1 3
l - -2 7 2003
PROPERTY AD0RESS: 35- Regatta--- ---------
TOWN OF BARNSTABLE
——Hyannis,Mass____------- HEALTH DEPT.
02601 Z
On the above date. I inspected the septic system at the above address,
This system consists of the following:
1 . 1 -1 500 gallon septic tank. MAP 2r,Z
2 . 1 -Distribution box.
3 . 2-500 gallon leaching chambers. PARCEL
Based on my inspection, I certify the following conditions-
4 . This is a title five septic system. ( 95Code)
5 . The septic system is in proper working order at the present time.
6 . The two 500 gallon leaching chambers are presently dry.
SIGNATUR /
Name : _ J_- P__Macomber_Jr __-__
Company : ,�g�geh per_ M_�g4mtZpC d_ Son, Inc .
Address :__@Qx _E_( ............
--Q_ej1SerYLUA,_ Na-_Q.2-632-0066
Pnone : _-508- 775_ 3 338
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connections
P.0 Box 66 Centerville. MA 02632.0066
775.3338 775.6412
•
s
,per
-\ COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
s
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:35 Regatta Drive
yannis, ass.
Owner's Name: Thomas McCafferty
Owner's Address: 5 Hideaway Lane
Duxbury,Mass . 02332
Date of Inspection: 4/1 5/0 3
Name of Inspector: (please print)Joseph P.Macomber Jr.
Company Name:J_P_Macomber & Son inc.
Mailing Add ress:gnx F ti
C 2632
Telephone Number: 508-775— 338
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
appfoved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
�✓ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
le-
Inspector's Signature kig Date: Jay
` The system inspector shall s mit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 35 Regatta Drive
Hyannis,Mass.
Owner:Thomas McCafferty
Date of Inspection: 4 15 0 3
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sys m Passes:
AO I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
The septic system is in Proper working order
at the_ DYPGPnt tjmp
B. System Conditionally Passes:
-A One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined" please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
,V6 Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
XID The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
Page 3 of 1 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 35 Regatta Drive
yannis,Mass.
OwnerThomas McCafferty
Date of Inspection:4 5 0 3
C. Further Evaluation is Required by the Board of Health:
_(& Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the
system is not functioning in a manner which will protect public health,safety and the environment:
i1,V Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet bu 50 feet or more from a
private water supply well". Method used to determine distance 1�✓,P
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 35 Regatta Drive
Hyannis,Mass.
Owner: Thomas McCafferty
Date of Inspection: 4/1 5/0 3
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No/
_ �/Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
/ clogged SAS or cesspool
!� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool l �y,,,t•�j�yy
/ � y'q� �e3,t�v
r/ Liquid depth in sesspeol is less than "below invert or available volume is less than h day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped 0.
Any portion of the SAS, cesspool or privy is below high ground water elevation.
_"Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
Water supply.
— r/ Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analysis,
performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this forma
,Vl) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either`yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes n
whe system is within 400 feet of a surface drinking water supply
�th system is within 200 feet of a tributary to a surface drinking water supply
he system is located_ t '— Y to a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 35 Regatta Drive
Hyannis,Mass.
Owner:Thotnas McCafferty
Date of Inspection: 4/1 5/0 3
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No/
t/ Pumping information was provided by the owner, occupant, or Board of Health
Were any of the system components pumped out in the previous two weeks
_ �as the system received normal flows in the previous two week period?
V Have large volumes of water been introduced to the system recently or as part of this inspection ?
Y 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
Y — Was the site inspected for signs of break out?
Were all system components,eluding the SAS, located on site?
Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition
of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems ?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b)]
5
Page 6 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:35 Regatta Drive
Hyannis, . ass,
OwnerThomas McCaf er y
Date of Inspection: 4 15 0 3
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): �J Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): },)Ie= 3�G°��•
Number of current residents: 0—
Does residence have a garbage grinder(yes or no): Q.S
Is laundry on a separate sewage syste�yes or no):-U [if yes separate inspection required]
Laundry system inspected es or no): E
Seasonal use: (yes or no):'
Water meter readings, if available(last 2 years usage(gpd)): 2 0 01 =5 7, 7 5 0 ga 1 lon s=1 5 8, 2 2 GPD
Sump pump(yes or no):AAd 2002=13, 950 gallons= 38, 22 GPD
Last date of occupancy:
COMM ERCIALMIDUSTRIAL
Type of establishment: _ 14
Design flow(based on 310 CMR 15.203): A 2Dd
Basis of design flow(seats/persons/sgft,etc.): 1411W
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):,40
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe): ,U19
GENERAL INFORMATION
Pumping Records
Source of information: WOW re,
Was system pumped as part of the inspection(yes or no):_
If yes, volume pumped:_'gallons--Vow was quantity pumped determined?
Reason for pumping: `1/
TYP OF SYSTEM
Septic tank,distribution box,soil absorption system
I00 Single cesspool
D Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank /lJA/ Attach a copy of the DEP approval
Other(describe):
Apro imate age of all components,date installed(if known)and source of information:
__t)"
G
Were sewage odors detected when arriving at the site(yes or no):
6
Page 7ofII
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 35 Regatta Drive
Hyannis,Mass ,
Owner: Thomas McCafferty
Date of Inspection: 4/1 5/0 3
BUILDING SEWER(locate on site plan)
Depth below grade: p2 Materials of construction:ARcast iron /40 PVCVO other(explain): Ap?
Distance from private water supply well or suction line: /D�¢
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight No evidence of leakage The qyt-ccm ; s
vented throu h the house vents.
SEPTIC TANK:locate on site plan)/,_AD 4Aa4Q5
f
Depth below grade:
Material of construction: concrete.Ud meta Ll fiberglass.,V&olyethylene
NDother(explain) AZ
If tank: is metal list age:.UD is age confirmed by a Certificate of Compliance (yes or no):4)11 (attach a copy of
certificate) �� /
Dimensions: GD� -�8
Sludge depth:
Distance from top of s udge to bottom of outlet tee or baffle:/ GCS
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How'were dimensions determined: # A i
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of-leakage,etc.):
Pump the spptl r tank annul rarba® disposal is present.
Tnlet & outlpt tees are in—p1ace The t- k n is RtriiGturally
sound and shows no evidence of leakage.Liquid level at the
outlet irim is 5111
GREASE TRAHHtt.�o locate on site plan)
Depth below grade:�/j'
Material of construct ion:'faconcrete imetal��berglasslAp olyethyIene,,tOother
(explain):_ A,94.
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: /X
Distance from bottom of scu to bottom of outlet tee or baffle: 40
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage,etc.):
Grease trap is not present
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property.Address: 35 Regatta Drive
Owner:Thomas McCafferty
Date of Inspection: 4 15 0 3
TIGHT or HOLDING TANKtAde(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: WA
Material of construction:x1A concreteAfl?metal,dAfiberglass, / polyethyleneP2,-!Z_other(expIain):
A)A
Dimensions: AM
Capacity: AM 2allons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: -42,!!_ Alarm in working order(yes or no):
Date of last pumping:4
Comments(condition of alarm and float switches,etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
Distribution box has one lateral No evidence of solids carry
njzPr Nn Pvi r1PncP of 1 PakagP i n o or r)ut of the box
PUMP CHAMBE &(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):I
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pump chamber is not 12resent
8
Page 9 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Regatta Drive
Hyannis,Mass.
Owner:Thomas McCafferty
Date of Inspection: 4/1 5/0 3
SOIL ABSORPTION SYSTEM (SAS): z/ (locate on site plan,excavation not required)
2-500 gallon leaching chambers . 25 'X13 ' X2 '
If SAS not located explain why:
Located: See page 10
Type
41V leaching pits, number:
Vleaching chambers,number:X,5�`5
[JD leaching galleries,number: O
AJO leaching trenches,number, length: O
Na leaching fields,number,dimensions: O
A)O overflow cesspool, number: Z)
innovative/alternative system Type/name of technology: e,
Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
etc.):
No signs of hydraulic failure or
ponding.Soils are ry.Vege a ion is normal.The two 500—gaI oT—n
leaching chambers are presently dry.
CESSPOOLS ,/P,(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
_Cesspools are not present.
PRIVA4 VG(locate on site plan)
Materials of construction: �ff
Dimensions:
Depth of solids:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):
Privy is not present _
9
Page 10 of 11
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 35 Regatta Drive
Hyannis,Mass .
Owner:Thomas McCafferty
Date of Inspection: _4 f 1 S/n i
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.
� s
0 0 `d
10
Page 11 of l 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:35 Regatta Drive
Hyannis,Mass _
Owner: Thomas McCafferty
Date of Inspection: 4 15 0 3
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: N A
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: NA
YES Checked with local excavators, installers-(attach documentation)
YES Accessed USGS database-explainhttp: //town,barnstable,us.ma.
You must describe how you established the high ground water elevation:
. sed: Gahrety R Millar Mnrlal 1211619A Ground water elevations above sea level.
sed: USGS:Observation well data June 1992
sed: USGS:Technical bulletin 2-000-1 Plate #2 Annual ranges of grniinrl
water elev tions_,Tanuary 1992
un
2-500 gallon lea
chambers
25 ' X131X2 ' 1
�eet
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the.bottom
' of the leaching pit and the adjusted groundwater table is
feet.
11
y •rrnnr.—n:rr.—'rrirn:mr•nsnrrrnnxsrrrrar::tee-retmr+nr:lrrtr*t fre*'ts..i'.sr�srtrmst —.
TOWN OF Barnstable BOARD OF HEALTH 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
•T]'1�T••.•:•i—S,tIT.�.�1T{t1T.TII'q:RTiT11r�TTTT!_•.,r{IR.Iti VMrw-9'RT -V"W/�'VWW" 7'1.11A
zrrr•r._,.
0 -TYPE OR PRINT CI.EARLY-
PROPERTY INSPE'CTL'D
STREET ADDRES$ 35 Regatta Drive Hyannis,Mass. ,
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Thomas Mc0afferty
PART D - CERTIFICATION Y
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & Seri- inc.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Stree Town or City Stat• LIP
COMPANY TELEPHONE ( 508 ) 775 _ 3338 FAX (
508 790 - 1 578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
ID
his address and that the information reported is true , accurate , and
omplete as. of the time of ,inspection . The inspection was performed and any
ecommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one :
VVSystem 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 wllicl, I have con cicted has found that the system fails to
Protect the public 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
copy of this c rt.ification must be provided to the OWNER, the BUYER
One
where applicable ) and the BOARD OF HEAL1'II,
* If the inspection FAILED, thle owner or"operator shall u
within one ,year of the date of the inspection, unless allowedpgradortsYste
he requiredm
otherwise as provided in 3.10 CMR 16 . 306 .
` partd -doc
L
TOWN OF BARNSTABLE
f,OCATION SEWAGE #
VILLAGE X161 9X," ASSESSOR'S MAP & LOTks2 �sl a0
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY SGO
LEACHING`FACILITY: (type) (size) (?Y\ a s�,
NO. OF BEDROOMS 3
BUILDER OR OWNER u�MnO
PERMIT DATE: 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 lea hing facility Feet
Furnished by ZnSp2 r, 40r) J • FO�tJ
ALi
r Iy sc) °.
QL 3 0 o
3 aq Y'r ,
ns«
y Y p 3a-
TOWN OF BARNSTABLE op -Ilal
Doe"
SEWAGE #;::;i4
.1"H:LAGE &2riZ 1,L)-7-ASSESSOR'S MAP LOT
INSTALLER'S NAME fa PHONE NO. 303
SEPTIC TANK CAPACITY
LEACHING FACILITY:(typ ��� �.j -,� ,� t (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �
� C
T
a
M
+S s
II - '
- No. 94- j Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0[ppYication for ligpogal *pgtem Con, 5truction Permit
Application for a Permit to Construct( V Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. 5 5-,2CCIGI %1-3 ZR Owner's
Name,Address and Tel.No. 7?1—M Z d
Assessor's Map/Parcel t 7 yA Nodlj�S 6,6!5 11w 81—b 6 /-,L)C_
Asa s/•®0T
Installer's Name,Address,and Tel.No. Yd,a —3 tJ FS Designer's Name,Address and Tel.No. q(a J--4/3
UCF W61&10 M- �N CO C49 P 19YlrP-I Al YE
Type of Building: /y Q79
Dwelling No.of Bedrooms J Lot Size sq. ft. Garbage Grinder Ad
Other Type of Building "Ob NAOE No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3-30 gallons per day. Calculated daily flow 4P6Q gallons.
Plan Date ®" o?/' Number of sheets Revision Date
Title
Size of Septic Tank /5 Q d Type of S.A.S.
Description of Soil 1 i 5 1z- 1p L�/U
Nature of Repairs or Alterations(Answer when applicable)
All/I
U VW
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 ' 5 of the Environ ental Code and not to place the system in operation until a Certifi-
cate of Compliance has be i surd b Bo th.
Signed Date
Application Approved by Date/e�`Z �(" Sr_
Application Disapproved for the following reasons
Permit No. Date Issued �l✓ ---� 99
No. - O Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
4PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
- Zippfication for Oigpo.5al *pgtem Cou,5truction Permit
Application for a Permit to Construct( 1i}Repair( )Upgrade( )Abandon( ) 306mplete System O Individual Components
Location Address or Lot No. 3 ,ec-6I¢%71-3 Z Owner's Name,Address and Tel.No. j 7/
Assessor'sMap/Parcel .2 51 QOIT
Installer's Name,Address,and Tel.No., 9d,k-. 3 a 5" Designer's Name,Address and Tel.No. YO j:-—•9 -3
W6 ICI�1161 w -bF CO ce)g P �k? 7 MYA�7 -
# y Type of Building:
Dwelling No.of Bedrooms - s =Lot Size jy "? sq.ft. Garbage Grinder(,V()
Other Type of Building 4/40D WAOPE ^No. of Persons Showers( ) 'Cafeteria( )
Other Fixtures '
Design Flow gallons per day. Calculated daily flow 66,) gallons.
Plan Date �r�` / Number of sheets Revision Date '
Title
Size of Septic Tank / G TypeNof S.A.S.
Description of Soil 115 Py5/Z P L19AI
/41_V fl i;l
Nature of Repairs or Alterations(Answer when applicable) /1 y ,g; /1'?: V V
L14 V � .
q 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 T
jllp,5 of the Env iron ental Code and not to place the system in operation until a Certifi-
cate of Compliance has been i su by Bo th.
Signed Date
Application Approved by k - Date
Application Disapproved for,the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( ) Upgraded( )
Abandoned( )by �6 l C / J•1G l7. CD C6 "
at 35 R FC47 e9 229, 14 Y has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer 17/`4 Designer ! a
The issuance of this permit shall n t bq construed as a guarantee that the s st m, ill function as de igned.
Date Inspector
�!7 '..' �f.� � -------------------- —————
No. -Fee z ' r_6
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mi!5po!5ar *.potem Cougtructiou Permit
Permission is hereby granted,t�q9 Construct( VRepair( )Upgrade( )Abandon( )
System located at S dc,ECA 7_77'i
and as described in the above Application for Disposal System Construction Permit. The applicant recdgnizes his/her duty to
comply with Title 5 and the following local provisions or special conditions:
// C
Provided:Constructi be c pleted within three years of the date of th• e . t.
Date: Approved by
�ESIl�►-i VATA
--51 WEE FAM ILA{ 3 l3®RLt�VK r/r--E PLA 14 OW 'BAUL 41Elz.E�"
4 o GA[Z 3A`'Q -'4Qfl Ge-
MAUI FLOW = 3 x 110 =VQ GPD Ler L% ` oL, A-TT-'A
Szrnc_ TANS ` X?1aD =[rlcd 6PD
USF 154V GAt_.
LwAc4lw, 5`(STMOK VEfv,.w * pr- �L,,tVA� a'Pvc PIPE
LY-,E 3 CULTEC Zac4 c-e330eAA+MaEos14�sTWt -- --- --- - -- 'A 1 Pz
4TTU GA-ticW AgEA 260'r% 1,IST.
�aX
31i 0 GPD s a`W_ 5F-A.41,sF - - z-0
,IFpuGATIOH a¢sA
51-DEWALL. AMA= 15"1 x-2 x2=lA�6 sF PLA,IJ V l l=-W - LF_AC_41t,6 -CRAM13Ee 5
TOTAL AYU4 s 44�313F FiNrsN la�A�
Y�c.Ot-�Tl�l �'� ��j/S'{Il�/i.� ; ii�... . ,ii .. l.v. i��v..�r•
OF r9gs� .` O '/5-%z
STEPHEN CULIFG 3/.{,-1�/z"
Y/ 4 . ' c AL YN U'+ 330 ° , r`I ail W�*5c E ►�F1S
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Dc� - l!� ,��Ci� �-�X���C�`�\,� "�--- �AI.tD svevf:YcZS •s�ls;l�ti�
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V-YoM BU 1LDt N.6 sOaXD NOT b&
i>5aV MD 6/,T1415u4sy PRoPE¢-ry LtWLKS. QPPLIG4NT:
A1-(S tD� ��i u�t�G GO �ri�
1 .emu
F
�� ZD �fl . i�O •fig
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�D lid �t c
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I
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'i
S4EE T 1 ol= `
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t_y J:LDw = 3 x ttc =VQ6f�V LOT �Dtz�vE
SQT1G TANS _ ��X?oo�=Lcfco 6PD
uSF 19500 GAL.
L"641►J, 5 '7MA VES�s1 * IF vC PPG
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4FpU CA110W AZEA RGQ'D D'sT.
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,t;PpuG�.� A¢sA 51
51t�wALL. At rWr �57 xzxs=iA$sF PL,4N VI(=W - L1=Ali-IIt.�, CµgM8Ee5
-TOTAL. A_ 444?V F�wsW C�zAa�
PEL?LOLA.'I'W4 '� L CJ {{Ill/�. iN.. ii �.�. si r ter•
�� 3 MAx „
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TOWN OF BARNSSTABLE
17
LOCATION SEWAGE
VILLAGE C TE ,1 LL Pi_ASSESSOR'S MAP LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY ,��
LEACHING FACILITY:(typt � ��( -,�1')�'-3;� (size) 7.l
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
O 3 acl
y 31v
YO
d0
� 1ORa (f'10-e
annf,
a 1 �� loo-r
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APPLICATION FOR BERCOLATIO TE T AND 'OBSERVATION
TION PITS
LOCATION44kK.� 'lsi . Wows .�
VILLAGE ��YAtJbJIS Cl V1L.L6 DATE J�°��.✓
APPLICANT :��a`WSI[ �(91L�1� (,, Joe
ADDRESS FEE ov
' TELEPHONE NO. 771-/0t�o' (Non-refUndable
ENGINEER ( e
TELEPHONE N0. 4'�
DATE SCH/EDUCED ,
•. (,S S L'SSOR•,.•S O bOi•R _ : q o�Sa
/ (� (APPlcant s signature
P• . . . . • • . . . . • O . . . . .
. . . . . . . . . . . . . . .
SOIL LOG
SUB-DIVISION `NAME 4ev WOODS PAT '
EtPANSION ,ARLA: :';.YE5 ✓.NO TIME : � '_
ENGINEER:'R. . .
TOWN WATE ✓PRIVATE 'WELL —
' VIA&fL� BOARD OF HEAL?
EXCAVATOR
SlCE.TCH (Street ''name, etc. ,dimensions .of� lot, exact location of `test hole a
• percolation . tests locate wetlands in and
proximity to test holes )
• NOTES:
i
hz
Q.rCA-
141•'36
PERCOLATION .RATE 'i)� AAW d�
TEST^HOLE NO:,. ELEVATION:
ST HOLE N0:
1 TE ELEVATION:
2 + 1
------
3 /f3S�9ic.� 2
SAj 4 -----__
7 l r1A11���. 6
g 7
9 a '
10 IS
10
• k`.rtT' aunt, .. .S • tY '1:.'3..... ._. w >...... 11. ..— s...' Y
12 .{S"zan, .41w-ArL.NC_:Y—.-'`.'.. r•
• , :. 12
13` 13
14 1�S
,
;1'6 15
' Sul
,TABLE'.`FOR SUB-SURFACE SEWAGE:. .. 16
LEACHING FIELD LEAN(; PITS
t .
LEACHING TRENCHES �✓
UNSUITABLE FOR. SUB-SURFACE SEWAGE. REASONS:
NOTE: ;ENG•INEAING. PLANS 24UST SHOW NUMBER• ASSIGNED •ON PERC TEST APPLICATION
ORIGINAL': 'COMPLETED IN ENT RE v nllr P
COPY:" RETAINED BY APPLICANT TURNED Tn BOARD OF HEALTH