HomeMy WebLinkAbout0129 MAIN STREET (OST.) - Health Main Street,,
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Osterville
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THE COMMONWEALTH OF MASSACHUSETTS Entered in compu
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Migpogal *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade
(XX)Abandon( ) ❑Complete System El Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
129 South County Road Osterville,M' Anne T. Ryan
Assessor'sMap/Pazcel Mass . 129 South County Road Osterville
Installer's Name,Address,and Tel.No. 5 0 8-77 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass . 02632 Box 66 Centerville ,Mass . 02632
Type of Building:
Dwelling XXNo.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder�0 )
Other Type of Building RES No.of Persons 2 Showers( ) Cafeteria( )
Other Fixtures
Design Flow 770 gallons per day. Calculated daily flow 77Ox1 1 0 gallons.
Plan Date 4 15 i 97 Number of sheets Revision Date
Title
Size of Septic Tank 2500 Type of S.A.S. 7-Cultec 330 Rechargers
Description of Soil M e d i um s a n d
Nature of Repairs or Alterations(Answer when applicablep m it cesspools. ( 3) Install 1 —2 5 0 0
gallon tank: 1 -pump chamber : 1 -Pump iight & a arm: 'j-Uu1tec 330
rechargers . 1-lift station in boat house .
2
Date last ins�dt .
tc
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this ar f He th.
Signed Date 4/1 5/9 7
Application Approved by Date
Application Disapproved for the fo owing reasons
Permit No. Date Issued
n / 7• 7 $ 50. 00 {
No.•. -'Wj Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
VYes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIPPlication for ]Dioponf *p6tem Con.5truction Permit
.Application for a Permit to Construct( )Repair( )UpgradeNXI �Abandon('
) El Complete System El Individual Components
ocation Addre s or L t No. Owner's Name,Address and Tel.No.
29 South bounty Road Osterville,M fine T. Ryan
Assessor's'Map/Parcel ., Mass. 129 South County Road. Osterville
Installer's Name,Address,and Tel.No.` — ""S Designer's Name,Address and Tel.No. 5087
— `�5j-.3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass. 02632 Box 66 Centerv,il,le,Mass. 02632
g Type of Building:
Dwelling, XXNo.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder(10 )
Other Type of Building RES No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 770 gallons per day. Calculated daily flow 770x1 1 0 gallons.
Plan Date 4/15797 Number of'sheets Revision Date
Title
Size of Septic Tank 2500 Type of S.A.S. '1-0Ul tec 330 flechargerls
` Description of Soil Medium sand
Nature of Repairs or Alterations(A-swer when applicable m j't cesspools. �' 3) Install 1—2 5 0 0
gallon tank: 1-p__p1 chamber: 1-Pump -Lignt alarm: -"u e c •33
recharge2rs. station in boat house.
Date last inspected,t' A
Agreements
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi
cate of Compliance'has been issued by this ir�of Health. ~,
Signed Date 4/15/97
Application Approved by4------ Date�r-,��/ ' . 5 7
Application Disapproved for the fo owing 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(aX�
Abandoned( )by J•P•Macomber & Son Inc
at 129 South County Road s ery e,lyiass. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. datpd
lviacomb
Installer J.P.Maeomber & Son Inc. Designer J.P. er-& Son Ine.
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
Date 11'1 L>1 Q . Inspector ,•'�,
�y
— ��"� / � --------------------------Fee $ 50.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mi5 po5ar *p0tem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon( )
4 System located at 129 South County Road Ostery l'le,Mass.
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.
j Provided:Construction
/must
bebe'e pomple d within three years of the date of is-p t.
Date: {"'f 1` Approved b
m v
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISK ,
WORKS CONSTRUCTION PLR.�,11'I' (WI'I'IIOU'1' DESIGNED PLANS)
• e
I Joseph P MaeombPr �r..�. . ' 61 c�rtily th;tt tltc application for disposal works
construction permit signed by n1C d:aed �L9.'Z— , concerning the
property located at 129 South_ t;z ga2d Os erv-i l 1 P MA ineets all ofthe
following criteria:
• There are no Nvetlands within 300 fc:;t of tlic proposed septic system
• There are no private wells within 15U l'�:ct of the proposed septic system
• The observed groundwater table .s I feet or greater bolo+v the boltoin of the leaching facility
• There is no increase in flow and/or cliangc in use proposed
f
• There are no variances requested or needed. 4
SIGNED : DATE: 4/15/97
LICENS SEPTIC SYSTEN1 INSTt,11.ER IN TILE TOIYN OF BA INSTABLE NUMBER
(Attach a sketch plan of the proposed s)stem. Also if the licensed installer posesses.a certified plot plan,
this plan should be submitted).
V
j 01
d
Al S l) TOWN OF BARNSTABLE _- ----_-_- �
LOCATION ` i) i1 t'ft r)^!l"�, 1�rJ SEWAGE #
Ly
VILLAGE U S !`�/� Vi/ !_ C
ASSESSOR'S MAP& LOT IG S*
INSTALLER'S NAME&PHONE NO.dOr--' Al A C U AJ/yeX r ,c-n V
SEPTIC TANK CAPACITY _'.O CEO
LEACHING FACILITY: (type) 7 R e C h /? c c t' size) 3 O
NO.OF BEDROOMS__ 7
`BUILDER OR OWNER
PERMITDATE: UCr-)
DATE:_
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply.Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
` \
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D�
DATE: _ 1 /.28/97
PROPERTY ADDRESS:_ '_Stephen Cutler
129 South County Road
Osterville,Mass . 02655
On the above date, I Inspected the septic system at the above address.
This system consists of the following:
T. 4-61x8l block cesspools. 1-31x3l block cesspool for
the boat house .
Based bn my Insrwction, I certify the following conditions:
1 . This is not a title five septic- systerm.
2. The Y
sewage system -is in failure.
• The system must be upgraded to a title five septic system.
3. 2-cesspools on west side are filled-'.to capcity. Scumlayer is over
the inlet and outlet pipe of the cesspools .
4. .Cesspool on west front corner of the .boat house. This cesspool is in
the hightide water. To Close to ocean. , Sliould not be
used. System must be upgraded.
SIGNATURE:
Name:-J. P Macomber Jr...
Company:_J. P.Macomber & Son- -Inc . ,
Address:_-B,,.,_66------3___,_-
__Cente!rvi11e LM_ass__02-632
Phone:---50.8_7.75_333a------- - -
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
•
rPH P. MACOMBER & SON, INC.
Tanks-Cesspools-Leachf leld:Pumped 4 InstalledTown Sewer Connections
Box 66' Centerville, MA 02632-0066
773-33. 3 7754 1
2
Uf
Commonwealth of Mossachusetts
Executive Office of Environmental Affairs
Department of
environmental Protection
Trudy Cole
aww.q
David B.Struhs
U.Gown. C*nv.habrwr
e
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 129 South County Road Osterville Address of owner
Date of Inspection: 1 /25/97 (If different)
Name of inspector.Joseph P.Macomber Jr.
Company Name,Address and Telephone Number.
J.P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338
CERTIFICATION STATEMENT
I certify that I have personally inspected the"wage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experisnce in the proper function and
maintenance of on-site"wage disposal systems. The system:
Passes
_ Conditionally Passes
eeds Further Evaluation By the Local Approving Authority
inspector's 9ignat Dade: l— �V g�
The Sysum Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection. 3
The original should be"at to the system owner.wd copies "nt to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY: �V�O
Check A, B, C, or D:
A) SYSTEM PASSES:
6 I have not found arty information which indicates that the system violates any of the failure criteria as de fin ;1a.310 CMR 15.303. (5
Any failure criteria not evaluated are indicated below. "� '°
B) SYSTEM CONDITIONALLY PASSES: eta i b
On.or more system components used to be replaced or repaired. The system, upon completion of the replacement or repair, passes
inspection.
Indicate M no,or not determined(Y, N,or ND). Describe basis of determination in all Instances. If'not determined', explain why not)
4&Alp, The septic tank is meta), cra:ked, structurally unsound, shows sub+taatial inAltration or uIlltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by tL. Board of Health.
(revised 11103/95) 1
One Winter Street a Boston, Mastachusetts 02106 a FAX(617) 55&1049 a Telephone (617)292.55W
PMW on RuycW Papa
I
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
PropertyAddre" 129 South County Road Osterville,Mass .
Owner.
Date of Inspeotio= 1 /2 5/9 7
B)SYSTEM CONDITIONALLY PASSES(continued)
&-ve Sewage backup or breakout or h0h static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH.
N6 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Y Cesspool or privy is within 60 feet of a surface water , 4t7 Ad"9e dzStVee)4
Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh.19,o4
_) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT`.
The system has a septic tank and soil absorption m and is within 100
rP system feet to a surface water supply or tributary to a
surface water supply.
AO The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well•
The system has a septic tank and soil absorption system and is within 60 feet of a private water supply welL
�7 The system has a septic tank and soil absorption system and is Is"than 100 feet but 60 feet or more from a private water
Supply well,unless a well water analysis for ooliform 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 lass than 6 ppm.
9) OTHER
The system consists of 4 block cess ools . Boat house cesspool
is less thanfrom the river. Water stands in pooi st n1gn
tide. This should not be used. cesspools on westside of house are
at full capacity. Pool on eastside is in operating condition.
The Sewage system must be upgraded to a title five septic system.
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (oontinued)
Property Address: 129 South County Road Osterville,Mass .
Owner; Stephen Cutler
Date of Inspection:1 /2 5/9 7
D) SYSTEM FAILS:
J •
Q.4;erI have determined that the system violates one or more of the following failure criteria as daBnad in 310 CUR 16.303. The basis for
this detarmined n is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
vLulure.
I Backup of"wage into facility or system component due to an overloaded or dogged SAS or cesspool.
Discharge or ponding of sMuent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
A& jV,,Static liquid level in the d}'rcribution box above outlet invert due to an overloaded or dogged SAS or cesspool.
yie Liquid depth in ossrpool•is less than 6"below invert or available volume is less than IN day flow.
At) Roquired pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).
Number of times pumped e65 �� l�»1" 100t4l v;e'
Any Portion of the Soil Absorption stem, cesspool or privy is below the,high groundwater elevation.
-- � rPtion System,
`16 LJ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Aay portion of a cesspool or privy is within a Zone I of a public well.
a 1 or privy is within 60 feet of a private water supply well.
An rtioa of cesspool D P
_ 7 Po P� P "Y
Any portion of a cesspool or privy is less than 100 feet but greater 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
ooliform 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:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions cdst:
do the system is within 400 feet of a surface drinking water supply
8LrT the system is within 200 feet of a tributary to a surface drialdng water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone n of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into hull compliance Ruth the groundwater treatment program
requirements of 314 CMR 6.00 and 6.00. Please consult the local regional office of the Department for further information.,
v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
prop.rtyAdd,s,w 129 South County Road Osterville ,Mass .
Owner. Stephen Cutler
Date of Inspection: 1 /2 5/9 7 '
Chad if the following have been dons:
Pumping information was requested of the owner,occupant, and Board of Health.
zone of the system componagta have been pumped for at least two weeks and the system bas been receiving normal flow rated
during that period. Large volumes of water have not been introduood into the system recently or"part of this iaspectica
SAs built plans have been obtained and esamined. Note if they are not available with NIA
, The facility or dwelling was inspected for signs of sewage back-up.
X/The system does not receive non-sanitary or industrial waste flow
, The site was inspected for signs of breakout.
_ZIAII syswm compoaaats4clu the Soil Absorption System, have been located on the site.
049— The septic teal manholes were uncovsred,opened,and the interior of the septic tank was inspected for condition of bafn or
teee,material of construction, dimensions, depth of liquid,depth of sludge,depth of scum.
, The size and location of the Soil Absorption System on the site has been determined based on a dsting information or
approximated by non-intruaive methods.
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub.
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
PropertyAddreas: 129 South County Road Osterville ,Mass .
Owner. Stephen Cutler
Date of Inapectiow 1 /2 5/97
FLOW CONDITIONS
RESIDENTIAL-
Design flow: us e
Numbs of bedrooms
Number of Current reetdeatr �✓�
Garbage grinder(yes or no):�S
Laundry connected to system(yes or no): i
3eaaonal use(yes or no):,Nf7
Water meter readings,if available: l 'G ry - ���1l -7A/)IAO .iAedky
Last date of oocupaary.
COMMERCIAL INDUS
Type of establishment: A1
Design flow: llona/day
Grease trap present: (yea or no)&Y
Industrial Waste Holding Teak present: (yes or no)—dy
Non-sanitary waste discharged to the Title 6 system: (yea or no).&44
Water meter readings, if available:__ /
Last date of occupancy:�e
OTHER (Describe)
-y
Last date of occupancy:_
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yea or no)_&J0
If yes,volume pumped: ns
Reason for pumping:
TYPE OF SYSTEM
Septic tank/d4trbution box/&oU absorption system
Side cesspool
AL Overflow cesspool
Privy
VQ Shared system(yes or no) (if yes, attach previous inspection reoords, if any)
Other(explain)
APPRO)aMATE AGE of all components,date indalled(if known)and source of information:� j'z'P K,2
Sewage odors detected when arriving at the site: (yes or no)&Y
(revised 11/03/95) 6
1(�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C.
SYSTEM INFORMATION (continued)
Property Address: 129 South County Road Osterville ,Mass .
Owner: Stephen CutlER
Date of Inspection: 1 /2 5/97
SEPTIC TANK:A�We' e ,
(locate on site plan)
Depth below grade:_/IY
material of construction:l/Oconcrete _metal _FRP—other(explain)
Dimensions:_
Sludge depth: '
Distance from top of sludge to bottom of outlet tee or baffle: A? _
Scum thickness: _ Aa
Distance from top of scum to top of outlet tee or baffle:_
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
•rity, evidence of leakage, etc.)
_ Septic tank is 'nott present. :
CREASE TRAP.
(locate on site plan)
Depth below grade-
*' w Material of conslnirtio 1. oncrete _metal _FRP _other(explain)
Dimensions•
Scum thickness.
Distance from top ut scum to top of outlet tee or baRle:A/A
Distance from bosom nl srum r^honom oI outlet tee or taille:_��
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 presen
s
V
Irevleed $/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(ooatlnued)
PropertyAddsess: 129 South County Road Osterville,Mass .
Owner. Stephen Cutler
Data of In,peotlono 1 /2 5/9 7
TIGHT OR BOLDING TANKMVs
(bcaw on site plan)
Depth below pads:,'
Matari.1 of oonetructbad�te_metal_FRP_other(uplaia)
A-)�
Dimensions:_Al
Capaciq•: as
Desi�a now Ms/day
Alarm ImL-
Comments:
(condition of ialat tee,condition of alarm and float switches, etc.)
Tight or hoiing tank not present
DISTRIBUTION BOXA7V-e -
(locate on site PILO
Depth of liquid level above outlet invert: A
Commsau:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage lato or out of bca,etc.)
Distribution box is not present
PUMP CHAM.BM-,dhVe—
(locau on site plan)
Pumps in workiaj ordar.(yes or ao)—&!�
Commazu:
(now condition of pump chambar,condition of pumps and appwunaaow,etc.)
Pump chamber is not present.
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddeess: 1290South County Road Osterville ,Mass .
Owner. Stephen Cutler
Date of Inspeotion: 1 /2 5/97
SOIL ABSORPTION SYSTEM OW
Oocate on she plan,if pow'bL;a oavation not rsquirad,but may be approximated by non-intrusfw methods)
If not determined to be present,uplaia e
TYPe
Fits,number
lasch chambers,number:
leach gallujac.number
—9
lWhin trenches,number,langth:
l.achiag fields,number,dimensions:
overflow cesspool,number.. 1
Comments:(nots condition of Vi} signs of hnMedium sand to Dine sau laJesu et rofe p oAis ghyl rauo via an f 'ui u on the (Mus707t"S
nn ,t.hp wP4tsidp of jh� house Eastside cesspool is in proper wor ing
r at the Dresent time. Uesspooi aT, boatinouse 18 . 1n �Une WcLLrjr'UT-1 t and shoulcl not be used at this time. Less than 501 from the river.
CESSPOOLS:r vegetation is normal.
(locate on site plan) rr� , 1
Number and oonsguratloa �s �� F "�� (17.5,� d )C D Y15.t S
�of of solids
inlet rv.rc:
Depth of scum layer, a
Dimensions of asapool
Materials of oonstructioa: � )�
Indication of Voundwater. 7 r.,V J¢r' T)/w s e
is m(aespool mat be pumped as part of iaspeotian)
Rec: • cesspools be pumped, They were not.
Comments:(note condition of soil,signs ofwpndi �o
dc, ere ispynMedium sand to fine san iu aoua i o
ff"r-6d ponding.
Sewage system is in ai ur The sewage sy e' must be unwra e o a i e
five septic system. Includes grease trap for garbage disposal..
PRIVY:d1W e-
(locate on site plan)
)Lattnials of Dimensions:_ 4V
Depth of solidsdsa� '
Comments'(note condition of 24 signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
Pri vv i a not. praaant.
t�
(revised 11/03/95). 8
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
428-6691
DEPTH TO GROUNDWATER
14.' + . depth to groundwater
r+pth,od of determination or approximati,op:
House. fiig _ qn he.k o—I .,;y 9 And.i ation of water on the east side
e Cs4sp—.House-
I � '
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iw.�.5?__U ld+b -
O AJ IYAM.Qv__4o_v.._.
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rrnr+rnrr+*-�r- rnrmr•nsrra�-r.n rrrrr.+r:-.r+e.+nri�+.*�wrrne+•n�t++r�r+�rtes+ .rn-.-rr-r..r-:..--.r...
I� TOWN OF Barnstable WARD OF HEALTH
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM IN9I'ECTION FORM - PART D •- CERTIFICATION I
�� �!^•T'��►••.''.:f-T.tif.^.trn 11 r.+n-rrrrirTTsei'trrTT.r1:7-t•f+1+n+r.7 a1TWC-TR.nR71.e AlOT.1�'t+rrR� .�.A ..-•.rrr•►--�• •�..w
-TYPE OR PRINT CI-EARLY-
PROPERTY INSPECTED
STREET ADDRESS 129 South County Road Osterville ,Mass .
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Paul Ryan,
PART D - CERTIFICATION J
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & S-ct' Inc.
COMPANY ADDRESS Box 66 Centerville ,Mass . 02632
Street Town or City State LIP
F COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 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 :
System PASSED
The inspection which I have conducted has not found any information
which indicates that the system
yste fails to adequately rote 9 protect public
hea1Lh 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 .
XXXXXXXXX System FAILED*
The inspection which I have con trcted 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 Wad. Date 1 /26/97
One copy of this c t.ification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEALTii.
* If the inspection FAILED, the owner or"*operator shall upgrade
within one year of the date of the inspection , unless allowed ort required
he m
otherwise as provided in 3.10 CMR 15 . 305 .
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THE COMMONWEALTH OF MASS CHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 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.
June 8. 1995
Acting Director of the ion of Water Pollution Control
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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.
June 8. 1995
Acting Director of the ion of Water Pollution Control
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LOCATION I
Z A d '� �'--'�� SEWAGE # 7 7 W
VILLAGE Q S 7'eR V1� 4 C ASSESSOR'S MAP & LOTA—LAIJL-
INSTALLER'S NAME&PHONE NO. Ad A C 0./1/f/-f1: *
' SEPTIC TANK CAPACITY •0 00 0 00 PIZA P C HALM ffe,<
LEACHING FACILITY: (type) 7 9 P C h A /? G eR'Isize) 3 3 O
NO.OF BEDROOMS
BUILDER OR OWNER Jam=e
PERMTTDATE: Gl -! '^ COMPLIANCE DATE: U 134 Cf 7-
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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