HomeMy WebLinkAbout0029 CURRY LANE - Health zu Curry Lane
Osterville P
A = 142 153
4,
t, z r39
• r.
0ATE :7/2/03
PROPERTY, ADDRESS:29 CuAay Lane y
02655
-------------- -
On the above date, I inspected the septic system at the above address.
Tnis system consists of the following:
1. 3-6 'X8' giock ce.6.3/2ooiz.
2. Ceaz/2oo z ate -in zeaiee.
Based on my inspection, I certify the ,following conditions:
3. 7h.i,3 .iz not a t.ij-je /.eve ze/2.t.i,C ;yz.tem.
4. 7h.iz .iz a zewage 3yztem.
5. The eewage ayztern .ins .in /22opea woak.ing oadea at the pae'6ent time.
6. 2-12ooiz have 10- 72' of wazte wate?. The th.iad cez.6poo.9 .i.s cL2y/
SIGNATUR
Name : _ J . P . Macomber_Jr .
____
COrripany : ,�4�gEh Pam_ M�s4m�€r a_ Son, Inc,,
address :-- VVED
EEp
5Q x._ri6-------------
J
- _ Qej'UeLYLLU,_ n -Q-2-632-0066 1200 3A
ul—
LEDPnone : 508- 775 38 EPT__ _ ________ HEALTH
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPH P. MACOMBER & SON, INC. -
Tanks•Cesspools•Leachllelds
Pumped & Installed
Town Sewer Connections
P.0 Box 66 Centerville, MA 02632 0066
775.3338 775.6412
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:29 Cu zay Lane
e2v c e, a-64.
Owner's Name G� e2
Owner's Address: Same
Date of Inspection:7/210 3
Name of Inspector: (please print) Jozeph P. 17acomge2 a2.
Company Name:j, P. Nacomge r & Son .inc,
Mailing AddressQo x 6 6
C�vn.�vn»il�l�v,� Plri.t,t_ n263z
Telephone Number: 5 Q R-Z 7 53 3 3 R
CERTIFICATION STATEMENT .
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fail s
g .
Inspec
tor's Si nature: '' Date:
The system inspector shall bmit 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 11
OFFICIAL INSPECTION FORM—,NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:29 Cu22y Lane
07e2u c e, a,3•s.
Owner: gigea.t.i
Date of Inspection: 712103
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
. System sses:
.424) 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:
7hv Av.l,iagp- .6ubtem iz in 122o/7e2 woltking o/Ldea ai- the
nno-.toll} _
B. System Conditionally Passes:
V6 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.
Ael)t 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:
/aZ/eObservation 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: 29 Cua2y Lane
73 te2v7 e, 71 a .
Owner: .1.i.P&enfi / .ic as
Date of Inspection: 712103
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:
V6 Cesspool or privy is within 50 feet of a surface water
AW 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:
AS6The 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.
10 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
A)6 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,I feet bu 50 feet or more froth a
private water supply well". Method used to determine distance l/
"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. koopy of the analysis must be attached to this form.
Other:
7htz .is a zewage eys.Lem. The .byd.tem. conh.i.6t6 o
giock ce,3,3poo a. 1he ce,3z/2oo 4 u/te to 16e/ztez, NEW
Sch. 40 4' PVC 12i12.cny wa.6 inzta-eZed 6126102 Peamzt —
266
3
Page 4 of 1 I ,
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address. Cuaay Lane
eay.c e, 711 a
Owner: /2.ichaad G,.gea.t.i
Date of Inspection: 7 T210 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
J Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
--LdVe, 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 'h day flow
✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
/bf times pumped�. T
_ VI 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.
I/Any portion of a cesspool or privy is within a Zone 1 of a public well.
arty 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
(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 now 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
_ i/the system is within 400 feet of a surface drinking water supply.
114e 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 If 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 corder Section D shall upgrade the system in accordance with 3 10 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 FO
RM
PART B
CHECKLIST
Property Address 29 Cu z zy Larne
.6 T e,zTz e, Na,6.a.
Owner:R.icha!nd G.igea '
Date of Inspection: 712163
Check if the following have been done. You must indicate yes"or"no"as to each of the following:
Yes No/
_X Pumping information was provided by the owner,occupant, or Board of Health
41- 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 ?
IVMCWere 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.
v — 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 I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Add ress:29 Ca zay Lane
e2y"c ZZ e, N a.s.e.
Owner:/2.ichaad �ige/z.-"i
Date of Inspection: 7112103
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):—.6— Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): »'0Y.�140
Number of current residents:
Does residence have a garbage grinder(yes or no): Cb
Is laundry on a separate sewage system(yes or no):Jai [if yes separate inspection required)
Laundry system inspected s or no):
Seasonal use: (yes or no): _ _ 4 9 2 /�
Water meter readings, tCava►lable(last 2 years usage(gpd)).
2001_91, 000 ya2.eone 2 . 3 G D
Sump pump(yes or no): AVV 2002=13, 000 a i i o R.6= 14 5, 21 Gl D
Last date of occupancy:ftuof J L-
COMMERCLAL/WDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): d
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 S system(yes or no): /9
Water meter readings, if available: �� )
Last date of occupancy/use: /Jj¢
OTHER(describe): .n59
GENERAL INFORMATION
Pumping Records
Source of information: None ava.iiag2e
Was system pumped as part of the inspection(yes or no): ee
If yes, volume pumped:_gallons-- How was quantity pumped determined? .elW
Reason for pumping: .1J
TYPE OF SYSTEM
Septic tank,distribution box,soil absorption system
Single cesspoolf;
Overflow cesspool
,-1D Privy
/00Shared system(yes or no)(if yes,attach previous inspection records, if any)
4LGlnnovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank. Nj Attach a copy of the DEP approval
O�LVOther(describe): 14dt
Aparox' t►rrl�e ae o all components,date installed(if known)and-source of information:
Were sewage odors detected when arriving at the site(yes or no): .V
6
Page 7 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 29 Cuaay Lane
.s e2v.e e,
Owner:/2 ichaad gige4.t i
Date of Inspection: 7/2 3
BUILDING SEWER(locate on site plan)
fr
Depth below grade:_
Materials of construction: cast iron _ 00 PVC, 1Gother(explain):
Distance from private water supply well or suction line: 1,4
Comments(on condition of joints, venting,evidence of leakage,etc.):
lo.in.tz aRReaz tight. No evidence o4 i akagv, 7hD AUAiDm i.}
vented th2ouyh the house ventz..
SEPTIC TANK: 460ocate on site plan)
Depth below grade: 24
Material of construction:.VZconcreteA�i9m eta W..4 fiberglassA/�olyethylene
other(explain) Ile
If tank is metal list age:� Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: /4
Sludge depth: ,(
Distance from top of sludge to bottom of outlet tee or baffle: 164
Scum thickness:A
Distance from top of scum to top of outlet tee or baffle: fX
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: ,�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.):
,SR-,{��6 E �661b�6 6 4 Ib 61•�--�4��4 B��r '
GREASE TRAINItlocate on site plar�
Depth below grade:
Material of construction:/)/I concrete4f metal,&!fiberglass,0polyethylene A/Aother
(explain): 124
Dimensions: �/X
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: ;44
Date of last pumping: 'd)"f
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
noriAe fana iA Qot—,a4g4,2rb�
7
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 29 Cu22y Lane
eav� e. az�.
Owner: Richaz„ �44eq.t.i
Date of Inspection: 11210J—
TIGHT or HOLDING TANKJ&& mnk must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construct.on: ZAconcrete VAmetal &AflberglassAAyolyethylenet1h other(explain):
Dimensions: VA
Capacity: AM gallons
Design Flow; Va. . gallons/day
Alarm present(yes or no):
Alarm level:_42& Alarm in working order(yes or no):
Date of last pumping:—A2?-1f
Comments(condition of alarm and float switches,etc.): ,
Tiah.t o2 hoid-irta .taakh a/te noit pze�3erz.t
DISTRIBUTION BOXJ&�L(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.):
lI -AtniPuiinn Pe)x iA nol ol?pAprzi.
PUMP CHAMBEMJ4�!(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):a
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Lump rhriatPvn noi 1?2P-6 r2
y n
8 . °
I
Page 9 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
'SYSTEM INFORMATION(continued)
Property Address:29 Cu2lty Lame
Owner: /2.icha zd q-ige/z
Date of Inspection: 712103
SOIL ABSORPTION SYSTEM (SAS): 1 (locate on site plan,excavation not required)
3-6 'X8' Biock ceh.6noo.2,3.
If SAS not located explain why:
Loca.>tP-d: 1P0 rLagp 10
Type
leaching pits, number:
,deleaching chambers,number:
AZ leaching galleries,number:
44d leaching trenches,number, length:
,�eaching fields,number,dimensions:
verflow cesspool, number: ) C�9ds
iUD innovative/alternative system Type/name of technology: /YQ IQZ�
Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
LoamU 3and #o medium 4 ' g Ao l No .t,t n,� .A n.4 hgr/nnuDir, .;eriL9/inv
alc_,aaad;nq .Splii aan. dau. Vnyv1r,11nn i.t nnnmr).P
CESSPOOLS:Z(Cesspool st be pu as f in spection)(locate on site plan)
Number and configuration: A IV
Depth—top of liquid to inlet invert: /
Depth of solids layer:
Depth of scum laver: l
Dimensions of cesspool:
Materials of construction: i
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
San2e ass agoye.
PRIVN;4. G(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
9
Page 10 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
29 Cuazy Lane
Property Address:
Owocr: /2icha2 7 e2 .c
Date or Inspeetioo: 712103
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system Including tics to at least two permanent rererenee landmarks or
bcnchmuks. Locate all wells within 100 (cct. Locate where publie.tiwater supply enters the building.
1
t
.r•
Mt '
r:
10
Page 1 I of 11
OFFICLA.L INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 29 Cu22y Lane
O� / v e
Owner /2ichaaz�z.c
Date of lospectioo:
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:
Obtained from system design plans on record}-if checked,date of design plan reviewed: NA
SGbserved site abuttin e /
( 8 P ro PRY observation hole within 150 feet of SAS)
NO Checked with local Board of Healh-exP lain: /yA
—
-YE,SChecked with local excavators, installers-(attach documentation
14e.,6Acccssed USGS database-exp lain:.ht112://.town• ga znz"tag-ee. ma. u,3.
You must describe how you establishes the high ground water elevat`ion: t
U-6ed. : Gah/zet 9 (�1.iiielt Modee. 12/16/94 gac wate2 e.Peva"t.ion6 aggove yea 2eveP.
Uzed: USGS • OaAe-u-n-Lian- wp-R.P rlallo. 2une 1992
ll,6ed: 11SGS •T^^4., :, /7a O.,, DOofy'.Tr "off ()no �.P�,fo #2 Annua-e ,zanaea o,e gzoan wate2
i oo nr Grou r
[Leaching
Pit :cct
GroundwaterP 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 !
feet. ! groundwater table is
11 -
y •nnnr+.-n.•r�.-.-rr �.nr•n�Tnn rnrmwtw+�rr+�.+.w.n ne'+tu�n�n,ey+ .�-.-�=.n.--,..`..r-..
TOWN OF /3u2R�fu� 2e BOARD OF HEALTH 1
0 T,.T••.....,_T11'_SWISUNFACF 9EWAOF DISPOSAL SYSTEM INNSPECTION FORM - PART D •- CERTIFICATION I
-TYPL OR PRINT CI.EARLY-
J
PROPERTY INSPECTED
STREET ADDRESS 29 Cu zay Lane Obteay.l iie, Maze.
ASSESSORS MAP , BLOCK AND PARCEL #
OWNER' s NAME i2.cchaad g i eat.i
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J P Macomber & SoR Ind".`
COMPANY ADDRESSBox 66 Centerville Mass. 02632
Street Town or City State E I P
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
omplete as of the time of The inspection was performed and any
recolnmendatiorls 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 :
A/_ System: PASSED
The inspection «hich I have conducted has not found any information
which indicates that the system fails to adequately protect public
heRlLll or Lhe 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 whidll I have con acted has found that the system fails to
Protect the public liealth and the environment in accordance with Title
5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
e , w 7
Inspector Signatur Date
ne copy of this certification must be provided to the OWNER, the BUYER
( Where aPplioable ) and the 130ARD OF HEALTII.
* If the inspection FAILED, th-e owner or"operator shall upgrade
he ayete
within one year of the date of the inspection, unless allowed ortrequiredm
otherwise as provided in 3.10 CFIR 16 , 306 .
partd - doc
-- -
SEWAGE INSPECTIONS G�
LC CATION 29 Cu22y Lane DATE
VILLAGE_ QA Ui .Qe. Na,3.6. ASSESSOR'S MAP & LOT!4 2- 16 3
INSPECTOR jo.6eph 1. (7acom9e2 Jz.
` SEP'I'IC TANK CAPACITY None 3-6 'X8' giock cezzpooi.6.
` LEACHING FACILITY: (type) (sizc)3500 ga-teon,3 I NO. OF BEDROOMS 3
BUILDER OR OWNER R-ichazd Cige2ti
OWNER MAILING ADDRESS
'Same
t
�k Fa
CpW ri»..
�s .• �AA.� its id
y ;ff
i
T
TOWN OF BARNSTABLE �� �
�C
LOCAflON , U A, V DoZ-266
VILLAGE 1/i'�.�P. dd�X���� ASSESSO 'S MAP& LOT I Y1=IS3
INSTALLER'S NAME&PHONE NO. Q 4 41/C ope
SEPTIC TANK CAPACITY W
L-EACHING FACU rrY: (type) '�� (size)
PO.OF BEDROOMS
BUILDER OR OWNER 6
ATE. [y •
Separation Distance Between the06 0 2-1la
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet leong fa ' •ty) Feet
Furnished by s
6',
�� i _
i
� �� ys �
os,
� '� � �.
�, ,
�` � ;
- ��
� � �
�� . � ��
p,,. .,. .
r
A
S.
•Nod —Cl Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
es
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Mi5 pooal *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) D Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
�9 &,e e v !we o srca ui Ile 21 CA R-Ad 61 b e,&-i' 6'0 t-sb(--off//
Assessor's Map/Parcel l U _63
C2 A 9 eakey J_} e Z�� �g`�a� �9� /
Installer's Name,Address,4nd Tel.No.. J J Designer's Name,Address and Tel.No.
k1/ �`4 Oro 7 rs
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building. OVA No.of Persons =Q 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. P S
Description of Soil
� I
Nature f Repairs or Alterations(An wer when applicably e /
a�S-c /r u Gv00
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 E vironment a and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this ea
Signed _ Date tv
_
Application Approved by _ Date vAT
C�
Application Disapproved for the following reasons
Permit No. Date Issued
t No, .-
d , 3 �3 � n� Fee. J
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: G!
es
- jPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE: MASSACHUSETTS21
'"
` v Z[pprfcatfon for Migogar *pgtem Construction Permit
Application for a. rmit to Construct( )Repair Upgrade Abandon p ( )Upg ( ) ( ) ❑Complete System El Individual Components �
Location Address or 6t No.`I C_,,i, Owner's Name,Address and Tel.No.
v4y Lia1�E C�srt %iN� k1Ch4nd 61bc?eti•
A'ssessor's Map/Parcel9 eu �,� ,vE 5v -S b� O$/� (�'e ee
14 �s ;,.., seu /e1< 5o 50k-Spa k 7�j/
I Installer's Name,.A"d]d"ress,qnd Tel.No. '�"' � ' Designer's Name,Address and Tel.No.
Q/O A !S J
Type of Building:
Dwelling No.of Bedrooms, : LoVSize r sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons- ;;, . Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day."Calculated daily flow �- gallons. I,
+, .,Plan Date Number of sheets Revision Date
Title
Size of Septic Tank =Type of S.A.S. �S
k
Description of Soil
Nature of Repairs or Alterationsp(Answer whenlapplicabl ) C
/G'�° C �L? l'�✓! /U fir Gam,'i7t` /,(P10 .
Date last inspected:'
i
r
Bement:
g
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 Environments zo a and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this ar .deal
.,
Signed R``e Date�� Q: , (�X
Application Approved by . C ro Date
Application Disapproved for the following reasons
Permit No. �� �-��l (� Date Issued 0 T
-------------------- -- ———————— --
THE COMMONWEALTWOF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired j�<)Upgraded( )
Abandoned( )by
at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.� < o dated l n /c)(.n I' -,,
Installer
Designer °; + fix• �. f
'! The issuance of i permit shall not be construed as a guarantee that the syste fun ion as
Date U 2.
4
t Inspector ,_: ':
_ No. `s �lL / ---- -------------
Fee _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS
Mfgpaal *pttem Construction Permit
Permission is hereby g, nted to Construct( 1)Repair)Upgrade( )Abandon( )
System located at t}_Q_►Z�( a �4�d
s,
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5'and the following local provisions or special conditions. I
Provided:Constr ction must be completed within three years of the date of this ermit.
Date: (n _ Approved by -
f �
`I TOWN OF BARNSTABLE ��
C
LOCATION C & y 2oo;— U
VILLAGE i//y/p . ASSESSO 'S MAP & LOT I
INSTALLER'S NAME&PHONE NO. v P ai ✓L a4e
SEPTIC TANK CAPACITY
LEACHING FACELITY: (type) 3"19� (size) JZ '-01n
NO.OF BEDROOMS_A
BUILDER OR OWNER 6 A�.
ATE: -DATE: L
Separation Distance Between the-6/2 U
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet le fa ' 'ty) Feet
Furnished by a
i
I
\ i
�-� r 17
f
DATE: _4/1..4/.97
PROPERTY 'ADDRESS:29 Curry Lane
Osterville ,Mass . RECEIVE®
02655 APR 1 .5 1997
HEALTH DE-PT.
TOWN OF EAPiNSTAQLE
On the above date, 1 Inspected the septic .system at the above addre-s .
This system consists of the following:
1 . -3-61x8► block cesspools .
Based bn my Insnectlon, I certify the following conditions:
1 . -This is not a title five septi ..c .system. .
2. The sewage system is i.n proper working order.
at the present time . -
3 . All three cesspools are dry and in structurally
sound condition.
SIGNATUR97:
Name J P Macomber Jn,
I- -
------. P_Macomber— & SonInc . ,
Address _ _6g........l......
Centeirvi11,eLMass__0.2632
Phone:
---50$_7_75_3338------- " 1
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
JOSEPN P. MACOMBER .& SON, INC.
Tanks-Cesspools-Leachf lelds
Pumped 4 Installed
Town Sewer Connections
P.O. Box 66' Centerville, MA 02632.0066
773.3338 775-6412
L
Commorrweafth of Massachusetts
Executtve Office of Environmental Affairs
De artment of
• Environmental Protection
William F.weld
lwnaf Trudy Cox*
AIpeo Paul Celluccl 600—"
David B.Struhs
U.Oo�nnr C=VrAwbrrr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Psop.,ty Address: 29 Curry Lane O s t e r v i l l e ,Mass Address of owner. 10986 N.
Date of Inspection: 4/1 4/9 7 (If different) Wa r s o n Road
Name ofImp.otor. Joseph P.Macomber Jr. St. Louis MO 63114-202
ss
Company Name,Addre and Telephone Number. '
J.P.Macomber & Son Inc.
Box 66 Centerville Mass . 02632 508-775-3338
CERTIFICATION STATEMENT
I astify that I have persoaal�y inspected the"wage disposal system at this addrees and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my framing and experience in the proper function and
maiatsaanc.of oa-site"wage disposal systems. The system:
lasses
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Face r� c
Inspector's 8lgaatur� �i /%`%dLs+s�u� Date: J -C/7
t�
The system Inspector Shall submit a copy of this lnspection report to the Approving Authority within
inspection. If the system is a shared system or has a design flow of 10,000 gpd or thirty(�)�of completing this
greater,the inspector and the sysesm owner shall submit the
report to the a '
pPropriate regional office of the Department of Environmental Protection.
The original should be seat to the system owner znd copses sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Clack A B. C, or D:
A) SYSTEM PASSES:
I haw not found My information which indicates that the system violates&Ay of the failure criteria as dennod in 310 CMR 15 303.
Amy Uilure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES:
—/1"Q- One or more system oomponants used to be replaced or repaired. The systam,upon completion of the replacameut or repair' es Pass
inspection.
Indicate yes, ao,or not determined(Y,N,or ND). D.acribe basis of determination in all instances. If"not determiner,explain wily not)
,04t-The septic tank is metal,cr&:ksd,structures unsound,shows substantial iatiltrration or euSltratso
immiasat. The �•or teak fa:lure is
system will pass inspection if the existing septic tank in replaced with a Conforming septic tank as approved
by the Board of Health.
(revised 11/03/95.) 1
One Winter Street a Boston,Masaachusetts 02106 Is FAX(617)556-1049 a Telephone(617)292.5soo
t�►MIW on R•cyt4d r•Pa
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(ocatinued)
Prop.rtyAadras 29 Curry Lane Osterville Mass .
Owner. Frederick W. Twichell
Dace of Iaspeot Om4/1 4/9 7
B)SYSTEM CONDITIONALLY PASSES (continued)
4".Ie- Sewage backup or breakout or ho static water level observed in the distribution bca is due to broken or obsawd pipes)
or due to a broken,settled or uarvaa dLArsbutiou boa. The system will pass iaspedioa if(with approval of the Board of
Health):
broksa pipe(s)are replaced
obstruction is removed
distrbAloa box is levelled or replaced
The system rquired pumpiad more than four times a year duo to broken or obstructed yipe(s). The system will pane
inspection if(with approval of the Board of Health):
broken pipes)an replaced
obetmedoa is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTHr
0 Conditions exist which require Author evaluation by the Board of Health is order to determine,it the system L&mng to proucx the
public lwkth,safety and the anviroamsat.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 13 NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVUWNMENTI
ti a Cesspool or privy is within 60 feet of a surface water
Cesspool or privy is within 60 feeCbf a bordering vegetated wetland or a salt marsh.
7) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERM M THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMEPM..
40 The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or oeutary to a
surface water supply.
V0 The system has a septic tank and&oil absorption system and is within a Zone I of a public water supply well
Eb The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well
Tha system has a septk tank and&oil absorption systam and is less thaw 100 feet but 60 feet or more from a private water
&UPPly well,unless a well water analysis for coliform bacteria and volatile osgank compounds iadicat&s that the wail is tree
from pollution from that facility and the presence of ammonia nitroasa and nitrate WtroPn is equal to or 1e.e than 6 ppm
J) OTHER
The sewage system consists of •3 6fx8l block cesspools
npgsj 7, s are dry and Gtriirti,ral l .r ani,nri
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 29 Curry Lane Osterville ,Mass .
Owner. Frederick W. Twichell
Date of Inspection: 4/1 4/9 7
D) SYSTEM FAILS:
•
_Q 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 abauld be contacted to determine what will be necessary to correct the
failure.
Backup of"wage into facility or system component due to an overloaded or clogged SAS or cesspool.
d10 Discharge or ponding of sffluent to the surface of the ground or ourface waters due to an overloaded or clogged SAS or
cesspool.
,V&e-- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
I Liquid depth in cesspool is Is"than 6"below invert or available volume is Is"than U2 day flow.
.0 Required pumping more than 4 Linos in the last year NOT due to clogged or obstructed pipe(&).
Number of times pumped
do 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.
�Q 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 60 feet of a private water supply well.
12 Any portion of a cesspool or privy is Is"than 100 feet but greatar than 60 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
_Q The system serves a facility with a design flow of 10,000 gpd or greater(Largo System)and the system is a significant threat to public
health and aafeq and the environment because one or more of the following conditions cdst
L6 the system is within 400 feet of a surface drinking water supply
0 the system is within 200 feet of a tributary to a surface drinking water supply
1, the system is located in a nitrogen sensitive area(Interim WeIIbaad 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 tall compliance with the groundwater treatment program
requirements of 314 CMR 6.00 and 8.00. Please consult the local regional office of the Department for Rather information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECICUST
Prop.AyAddre.w 29 Curry Lane Osterville ,Mass .
owner. Frederick W. Twichell
Date of Inspeotionr 4/1 4/9 7 •
Check if the following have been done:
zpw,pim information was regwsted of the 9_a_r�occupant,and Board of Health.
Woes of the eystam.components have been pumped for at Is"two weeks and the
sum has been receiving normal Dow rates
during that period. Large volumes of water have not been introduced into the r
system recently or as part of this inspection.
IVA As built pleas have been obtained and examined. Now if they are not availabla with N/A.
, The facility or dwelling was inepedad for signs of"wage back-up.
�Th.system does not rood"noasanitary or industrial waste Dow
XTh,site was inspected for signs of breakout.
, All system component+, Wdudiag the Soil Absorption System,have been located on the site.
N414�— ,Tbs septic tank manholes were uacpverad,opened,and the interior of the"ptic tank was inspected for condition of bafn or
teas,material of construction, dimiasioas,depth of liquid,depth of ahwp,depth of scum.
The airs and locatioa of.the Soil Absorption System on the site has been determined bald on existing information or
f/Ta pra dmatod by noa•Intrud"methods.
The facility owner(and oocupants,if diffmat from owner)were provided with information on the proper maiatsaaaos of Sub-
Surface Disposal System.
(revised 11/03/95)
f
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAddross: 29 Curry Lane Osterville ,Mass .
Owner. Frederick W. Twichell
Date of Inspectiow 4/14/97
FLOW CONDITIONS
RESIDENTLAL-
Design
flow_ .-al*Y r
Number of bedrooms:
Number of arrreat residaata:�
Garbage grinder(yu or no) `7
Laundry connected to rystam(tea or no):.A1_-;'
Seasonal use(yes or ao): S _ yyJ/
Water mStar:vadirrgs,it available' �11= 5 i
Last data of occupancy: IZAlk
COMMERCIAL fINDUSTRLAL
Type of establis at: AI;6
Design flow:plloaa/day
Grease trap
present: (yes ao
). 14
Industrial Waste Holding Tank present: (yea or no)-4124
Non-sanitary waste discharged to the Title 6 System: (yea or no)A1
Water meter readings, if available:
Last data of occupaacy: .42 _
OTHER. (Describe) 444
Last data of occupancy: VI
GENERAL INFORMATION
PUMPING RECORDS Had soave of ormation:
System pumped as part of inspection: (yes or no)
It yes,volume pumped:
Reason for pumping: �
TYPE OF SYSTEM
Septic toWdistrOnWon boa/soil absorption system
8iagle cesspool
Overflow owpool
Privy
Shared system(ya or no) {if yes, attach prsvions inspection records,if any)
V-1� Other(explain)
APPROXIMATE AGE of all components,date installed(if known)Had sours of iaformatioa /���
Sewage odors detected when arriving at the site: (yes or no)
(revised 11/03/95) 6
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C-
SYSTEM INFORMATION (continued)
Property Address: 29 CUrry Lane Osterville ,Mass .
Owner: Frederick W. Twichell
Date of Inspection: 4/1 4/97
SEPTIC TANK:A'UC e
(locate on site plan)
Depth below grade:_��'
Material of constructio -4concrete _metal _FRP—other(explain)
Dimensions'
Sludge depth:_
, W
Distance from top of sludge to bottom of outlet tee or baffle:-46.4--
Scum thickness: Vh
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffle._
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffle.,. depth of liquid level in relation to outlet invert, structural
riry, evidence of leakage, etc.)
-- Septic tank is Eot present. o
GREASE TRAP,A0`V(—
(locate on site p+an)
Depth below grade:.it)X
Material of cons►rt.irtion hA;oncrete _metal _FRP _other(explain)
Dimensions•
Scum thickness:
Distance from top wi scum to top of outlet tee or baffle:_Av—¢'
Distance from bottom of from to bonnm of outlet tee or oahte:,1ff
Comments:
(recommendation for pumping, condi—n 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 preset
(revised 6/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
pr.psih,Addr.m 29 Curry Lane Osterville ,Mass.
Owner. Frederick W, Twichell
Date of Inspection: 4/1 4/97
TIGHT OR HOLDING TANK
Aocats on she plan) s
Depth below p'ade:-d2'
Mat.rial of ooast:uction:(�ooacret.,_p�eW_FRP_other(e:plaia)
.uA
.v
Dimaadoas: 1!A
Capacity ns
Design flow:== onddsy
Alarm 1evs1:
commaats:
(condition of inlet tea,condition of s1arm and float switches,atc.)
ia or hoiding tanks are—no-f present
DISTRIBUTION BOX�e1A-4
(locate on site plan)
Depth of liquid level above outlet in"m Vl� -
Comments:
(note if level and distrilution is equal,evidence of solids carryover,evidence of iea><a�into or out of box,etc.)
Distribution box is not presen
PUMP CHAMBERALe'vc..
(locate on site plan)
Pumps in worldng ordar.(yes or no)
Commants: .
(note condition of pump chamber,condition of pumps and appurtenances,stc.)
PiimL nhamher is not present
(revised 11/03/95)
U
SUBSURFACE SEWAGE DISPOSAL SYBTKW INSPWnON FORM
PART C
_SYSTEM INFORMATION(Continued)
Prop.rt7Add,..s29 Curry Lane Osterville ,Mass .
O,.ne,s Frederick W, Twichell
Dal.of IA P-Q too:4/14/9 7
SOM ASSORMON 6YU M OW _e�
Oocate as site Plan,if you bls;aoavatioa not eaqui:+d,but may be appr mum"b7 noa latrusiw metbods)
It not d.tarmiasd to be present,aplai
leac p4 number I
1AMbiaj eaambas,number
bwxla,, number l.ar
1.achiaj aalda,number,dimsasions:
ovardow wsspoo4 number. f
Commanu:(no"Condition of e4 aiva+of hydraulic tanure level of pondinm oondWon of veSetation,etC.)
Mariinm aanrl t.n fine ssrd * Nn -,igna of hydraulic failure or Don ding:
Allget- .+J _ -0 e. nnrm�� Ra c.omor + f'i•1 r'll� .� O�•�T�p.�Tl"m=Pal #'n nnP of
t m . iAPt—e s a n 4!8- iq ge e g w9l2kilag—��c�o r.
CESSPOOLS:,
Goes"on site plea)
Number and ooafigumdoa:
Depth-top of hquld to inlet in
Depth of&lids l yar
Depth of scum IV=
Dimension,of owpool:
3Satarlala at oon.: wn e
z o<pwawatar.
�*( b pum as part of inep.ccion)
(not. C 0 �+ t d�aulle failtv+,level of poadi,s�Condition of vr�etmioa,
Me' ilutve son o i e s No signs of hvdraulic failure or ponding•
getestinn is normal ,--
PRIVY: ae_
(locate an site PILO
HataskL of oon:tnuCd=-_- .[/J¢
Dime-
Depth of sions:��1
Cvmmeata:(note c=dttiaa d s4 siPs Of hydraulic MUM,level of pon&4t Condition Cf vegV tjon,-et,
)
v r
(revised 11/03/95)•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE L:SPOSAL SYSTEM:
include ties to at least two permanent references landmarks. or benchmarks
locate all wells within 100 '
Centerville Osterville Marstons Mills
Water Company
► .w.ege 66917�y X'a f • 16 ?�
�Y9
y
DEPTH TO GROUNDWATER
-30 '.+ depth to groundwater
rnpthod of determination or approximation:
R6t)a e .and .ins'tat : -u��n' ys'tems .zn.'this area. No water ever
_encountered at- T61 o e.
I
•Ttnrw.—nFr7�'n—fn.—mr•nTewr�"'nrta�RrsrRr.T•►1►n►11►R*RTn�r71ft1A'v��rtRT
TOWN OF Barnstable BOARD OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
`� �•••T!•1�T••.-: .—T.in.�.�rnJnr.'In•RtfairwT+eer�an7en:rt•irloPRl77 It.l. `.TI'T•T1• �•.
—TYPE OR PRINT CLEARLY—
PROPERTY INSPECTED
STREET ADDRESS 29 Curry Lane Osterville ,Mass . '
.0 e
ASSESSORS MAP, BLOCK AND PARCEL Ii /X,`" �
OWNER' s NAME Frederick W. Twichell
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr,
COMPANY NAME J. P.Macomber & -5b)a Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
stroot Town or City state Lip
COMPANY TELEPHONE ( 508 ) 775 _ 3338 FAX (508 ) 790 _ 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true , accurate , and
complete as of the time of .inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one:
XXXXXXXXXXXySysteui PASSED ;
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh 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 wtlictl I have con tcted 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 form .
Inspector Signature 7 d�� Date 4/14/97
One copy of this ce tification must be provided to the OWNER the BUYER
( where applicable) and the BOARD OF HEALTH.
* If the inspection FAILED, the owner or"operator shall upgrade
eYete
within one Year of the date of the inspection, unless allowedorthe requiredm
otherwise as provided in 3.10 CMR 16 , 305 .
partd .doc
Jos ��r
THE COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
Junc 8, 1995
Acting Director of the •Ion of Water Pollution Control
d
1