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Home My WebLink About0027 BRIDLE PATH - Health 27 'BkiDLE PATH, MARSTONS MILLS 1 . r y ,a 093 20.00 THE COMMONWEALTH OF MASSACHUSETTS . BOAR® OF HEALTH ...---.."."Town.................OF... Barnstable Appliratiun for Biupu,ial Works Tunutrnrtiun rrmit Application is hereby made for a Permit to Construct ( ) or Repair 4X) an Individual Sewage Disposal System at: 27 Brida_. _Path Marstons Mills. --•-.....I............ -•-•----•---•-••--•-----.....-•--•--•--------------------•-----•--•---------------........._------ .............. Location-Address or Lot No. Wilma Treglia ....._..... Owner Address J.-P.Macomb.er-_..Jr._------•----------------------•------------------.---- .........----•-----....---...........------•-•---------•-•----•--....•--........---......--------• Installer Address UType o= Building Size Lot............................Sq. feet Dwelling`--X No. of Bedrooms...........3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QOther fixtures -------------------------------------------•---------------------------------------------------...-----------------------------...-----••-----------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons " Length................ Width---------------- Diameter................ Depth................ Disposal Trench—No. ...,................ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by...........---------•-------------------•------------•----•-••. •-----. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water................................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. M •---•-------------------------•------------•--•---••---•----------.......------------------...-•--•-........................................................ 0 Description of Soil............................. x -- - ------------ w ------------------------------------------------------Sand & Grave T--------------------------------------------------------.._.....-------....--------------------------------- � ---------------------------- ------•-----------------. . ------------....------...------------------------------........------------------------------------------------------------------...... U Nature of Repairs or Alterations—Answer when ap li - ._._ gall ei ---le-ai2 ih -ff--- Sit---------------------------------- ------------------------••-•--•------•••---•----------------------------------••----•-------•---••-••----•------•-•--•--••------•••-•--•-•-------•-••--•--------------------------------................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'TIE 5 of the State Sanitary Code— The dersigned further agrees not to place the system in operation until a Certificate of Compliance has bey, issuedVy !Werd of heal Signed.. . ...--------•--•--••--. ....9/251_$9........ Date Application Approved By...........-• - ''s a �" Date Application Disapproved for the following reasons----------------•-----------•-•---------------......-----------------------------•------....------•--•-•--•-•-... ---------------------------------------------------•-------------......---------••---------•-------------------------------------•-••-•••---•----------•---•---••••------------_----- --•--•--..••-•- Date Permit No........... ? � -V-•--•------------A Issued-----•----•-----•------------------------ ate Date Veb THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct ( ) or Repair X�X ) an Individual Sewage Disposal System at: 27 Location'Address m Lot No. Owner Address -'----------'----�--- ------'-----------------------'-'--'--- Installer Address Type of Buildifig Size Lot.............................Sq. feet Dwelling No. of Attic ( ) Garbage Grinder 04 Other—Type ,f Building ............................ No. of persons............................ S6o~cco ( ) -- Cafeteria 04 Other fixtures _.--,,.r--..--.--.-__---__,-,..__--.----__..__---_.----_--_----._______ Design Flow............................................ per person per day. Total daily flow...................... ............. . Septic Tank—Liquid Width---_-. D�o�c�r--_�-- Depth----_- Disposal Trench—No. .................... Width.................... Total Length..................... Total area....................sq. ft. Seepage Pit No--------------------- .................... I)optb below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) | ~~ Percolation Test Results Perfocozedbv-----------------------_------- Date........................................ | Test Pit No. l---------......miouteayerinch Depth of Test I,d--..----' Depth to ocnuod water........................ rX4 Test Pb No. 2................minutes per inch Depth of Test Pit.................... Depth noground water-------.--- � pq -.-_----_.--'_-_--'__--_--_--------------'--------____'---____'-__ ~~ Description u{ Soil....................................................................................................................................................................... -_-'--_—..__...'--__-'_-----._--_-__---__--'--_-_-.---_-_----'------'-.-_-_-__.-_----- avel ----'''-_-'--_-----.-. --_'--_--_-'-------_----__-_----------'_'-___-- � Q Nature of Repairs or Alterations—Aoswer when � | '`;IllOn lezcilz� - o� / -_--_-----_--_-'-'_-_'----_---_---____._---_-----.--_.-__.-='-.....-.-..''-_-.-____- ' Agreement: The undersigned ogrcco to install the uforedcscribed Individual Sewage Disposal System io accordance w I ithi the provisions ofIZTIE, 5 of the State Sanitary Code— The uqdersigned further agrees not to place the system in operation until a Certificate of Compliance has � ................ 8�yl�uboo z��zovcd By----- ___�'_.�_��.'�_�...�__� ^� u"te 8yylicudou Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date � Permit zw Date ~� THE; COMMONWEALTH oFwAssAonussrrs BOARD OF HEALTH | ` .................. .... ...........OF..............�,3x].&J...blB........................................ | | �� m�� u��K�ulKt��r�� THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (}{ ) by....... ...:E��'n�e�-��--'-T-�''-'------'-'-'-'-'------------'-----------------------------'----------- at___ __�ridaIP8th_MorstOnG �8�� ... -..._.--__' -__-__---__'-__---_-.---__'_.-----_-----_---._--____------- has been installed in accordance with the provisions of TITJ 5 The State Sanitary Code as described inthe application for Disposal Works C000truc �nn Permit I�o.-.-�,,,��-�...-. --- datof---. -.-------.----. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS AGUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE I� D-------------- ---------- »p��or-------'��_ -----...--------' ................ � ` ' / THE ooMMomvvsALr* or wAsaxoHussrrs BOARD OF HEALTH .......................OF-----}baxn e................................'- I�o.-��.�-_'�-�-� � �ms__& P I�_O� MoVasa� Workii Tonstrurt0on �� t Permission ishereby granted--.-��°��K��8l��-J��-----.-.-------.-_-.--.---.------.-'---- 0o Construct ( ) or Repair (X) no Individual Sewage Disposal System | at Iyo........2!Z-}��j'�i��l-��til-��°�Gt1}��-��2'l!��_'-- .. Street uo�� oo�� D�� u �uatc�t�o ��t w | ^ � - -\ ..-- � -----------------'aBoard ^�.�� ..--_----------.------ � [y��Il------'.--__-----------_-�.---------' Health-- LO{C-ATION SEWAGE PEcRMIT NO. VILLAGE If-IX s7-el Ai/I/s IN.STA LLER'S NAME & ADDRESS Uh en. I— OWC Co B U I'L D E R OR OWNER Rccxg 14Z 73 e,&C- D ATE PERMIT ISSUED ` DAT E CO-M Pl. IANCE. ISSUED �o� 73A cK r3®X 17i A L rU�✓` i Lam':�vl� /�'e�c°.ry��G'r� + �: �' s iol %� :t4 3 •9 \ \ \ X7 idle. Ll No.......... 1 .......-- F1�8... ....... THE COMMONWEALTH OF MASSACHUSETTS BOA F HEALTH T Apli iration for Disposal Works -Tonotrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst ,� -7 ........... 1� : :i. .1. : .. ............................... ........•••--••--•-••----. --• ... ---- --.•-•---..............•-•---.•...........••. t Add No. / i s - - .Loca C?�a-!ress G_ �o� f f e..... ..._ tS1 �f?.ft�. l f ;... 1a _ Ow !�' J�lZ GefZ L ..... _.... � � Installer Address L, Q Type of Building Size Lot_.Q!_____/.__.........Sq. feet U Dwelling—No. of Bedrooms...-�.I................ _ . ._.._..... .Expansion Attic ( ) Garbage Grinder (iV)O `., Other—T e of Buildin yp g _...�.:Z No. of persons._....... ............... Showers ( ) — Cafeteria ( ) aOther fixtures ---------------------------------------•---------------------------------------------------------•..... ••----- Design Flow........ •.....................gallons per person perday. Total d flow------------ . .................gallons. 04 Septic Tank—Liquid capacitylqf?q_gallons Length.......6...... Width....._._........ Diameter................ Depth................ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosin t nk� ).�C, z �� Percolation Test Results Performed by-----=�:....'?�L.................................................. Date____.__---•��/7___/•-•_--... ,aa Test Pit No. 1..Tq.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth,-of,.Test Pit.................... Depth to ground water--________-••----_--_-_. ;; ��. .....•i.-• ......�...••-- O Description of So --------- -----�...... .......---3.6- ..... ...wil....... ! x v. �L U. Nature of Repairs or Alterations—Answer when applicable............................................................................................... ••---•--•---------•------------•-•-•---------•-•---•----------------------••---------•-••-•--•--------•---------------------------------------•-----------------------•--------•----••••---••-••••••••. Agreement: The undersigned agrees to install the aforedCescri ed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary oe The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee is ed by the r b _r o `Si d. ... ... ..... -• - -d .�....� g . Date Application Approved By•.... ...... ------------- ---•--- ......� Date Application Disapproved for the following reasons----------- ...................................................................................................... .-•-------............................................................................................................-•••-••----•--•--••••-------•••-••-•-----•--•••--•-•--------•--•--•-••••......•... Date PermitNo.........................................................: Issued•....................................................... Date 77, No...........7f...... THE COMMONWEALTH OF MASSACHUSETTS BOARD:.-QF HEA LTH( 7-ro--- N...........OF..... TA U-& - ----------- .. ............................................ �.Vpfiraftou for Uispoiial Works'.Tonstrartion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Syst `7 e .................................................. AT 14 ----------------------"---------- ..................... Locati Ad Z� 0 Wd T14v1?PZWqP'j'* DR. IVXZ.M� .......................................................................... 0, r k1l R 1P I C . .........W 01 ..............................Pa..........US&.....ft .4............................... ........qk . ......................... Installer, Address Type of i�ilding Size Lot_5;�%,-9/7.. I -------------- .....Sq. feet Dwelling—No. of Bedrooms.._.......................................Expansion ttic Garbage Grinder Other—Type of BuildingI.......:L................ No. of persons---------------------------- Showers Cafeteria PL4 Oth fix�tres -------------- <4 - ----------------------------------------I------------------------------------------ . ........... p5# Design,,'Flow...... ..................gallonk per person day. Total daiLy, flow..............3.3.. .............gallons. iX Septic Tank—Liquid capacity./.'0..?..4.'_.gallons � Length......A;..... Width---- Diameter................ Depth................ Di"spbsalTrench—No.....i............... Width.................... Total Length..................... Total leaching area....................sq. f t. Seepage-Pit No..................... Diameter.................... Depth, below inlet............. ...... Total leaching arm......... ......sq. f t' Z Other Distribution box.( Dosir t Date................ ........ Percolation Test Results ................ ........................ it Performed by, ---------*--------**------ .. Test Pit No. I................minui�sperinch Depth of Test Pit.................... Depth to ground water-------------------I— Depth of Test Pit------------------- Depth to ground water. Test Pit No. 2.,...............minutes per inch -----................. ....... .......... lv�� ------- 0 Description of Soil...............................t.......... ....................'T' -04. -----/---- --------------------------------------;.................................. ......................................................................................................................... U ---------------- ...........................................................................................t----------------------z.................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...............................................................................I.................................................................. ............................................... .. Agreement: The undersigned agrees to install the aforedes * d Individual Sewage Disposal System in accordance with Co the provisions of T I T ILE 5 of the State Sanitary The undersigned further agrees not to place the system in operation until a*Certificate of Comp"llanceha,, be i is ed by th W—r—dd—olv�1aed Sign .... ........................... ........................................ ............................... Date Application Approved B ..... ..... ..... ...... y-------- ------------------ ... Date Application Disapproved for thejollowing'.reasons: ............................................................................................................. ..........................................................7............................................................................................................................................... Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARJ;�_OF HEALTH WN z ....................... ...........OF..... .. '4 k4V 7a.t . .................... ........................:.................. Tatifiratr of Tompliantir THIcf IS TO CE TLFY, Thit thp.1ndividual Sewage Disposal System constructed or Repaired 'A TI b .............. y ...... ------------------------------------------------------------------------------------------------------------ 3W .1 -T-14 I ler 4,0. r at.......4pt....... .................................. ................................................................ ----------"........ ................... has b�oii installed in accordance with the provisions of TI 5 o� The State Sanitary Code as described in the aplilication for Disposal Works Construction Permit NO..__9)7_y.................. dated....... ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNMTIONSATI,SFAr).TORY. Z DATE............................... ........ t 2C ..........*.............................................. Inspec or_ THE COMMONWEALTH OF MASSACHUSETTS BOARe—eR HEALT4K & 0_6 100A)TIA 0 F........................................................ . .................. N �_f....... Dispoo orkii Tondr rtion Vamit Permission is"hereby granted....... Q ....................................................... . ......................................... to Const epair an—ftidividual isewage Dispos Sy0ftm 'I.... , Ij... ............. at No.....rAck 7 - A ./ .......... ........ .Ft M �r�................................. ................... Street as shown on the application for Disposal Works ConstrucAtionP it N Dated..... ........ .................... Boardlof�HMt DATE......................................... ................................. FORM 1455 HOBBS & WARREN, INC., PUBLISHERS � s rf .i•. . �. 1. , . L; i r ,,yy '� .y^yn• , tip•/ - ,. ` , y� t __ g31°¢�9 � SS " F, j. /du0 < 4A ;EXPANJ1014 t- i'PA 0 INr ` P/sT.dro?c \ Tyr ✓wC � ' p�z c - d' NJ ZH Mq O ROBERTrn s P. BUNIKIS �. r p No_22162STS Q r z U10 LEGEND , EXISTING SPOT ELEVATION ` OA0 CERTIFIED PLOT PL�tN EXISTING '.CONTOUR ——— 13 6 �ra-ivy Ft ISHEu SPG'P ELEJATIOAI-: - - �T [ _ I"IRDrISHED'' CONTOUR 0 — IN APPROVED , -- APPRO!/ED , BOARD OF HEALTH �A A h8efA RM µk � - .. AGENT' _ SCALE = 6 DATE, _ ' _ 1 CLIENT PROPOSED .a' •'D14E®G'� E'NG/NEf04/lVG CD:IIbG� 7-7 r. cJ 'ICE I CERTIFY THAT THEO ..'t EOISTERE REGISTERED JOB N0. _ "� �'._ BUILDING SHOWN'. ON - THIS 'PL A' CIVIL LAWD CONFORMS TO THE ZONING LAWS `Ef�OIRIEER SURVEYOR J1 DR.®Y' ._-_�— OF BARNSTA LE MASS. CH. BY= P � 33' ,NO.. MAIN ST 712 MAIN ST , • �<' ?2. ,. SO.,IYAFIMOUTH, MASS. HYANNIS, MASS. T F Z � _AT - — 1 - A :--- Ey —SHEET 0 D E REG. L RID SUR,V YQR l _ ' L r 20:FT. M/N. . NOTE /F E/TNFR `TNE'.SEPYI G .T.4Al�/C ? r N /Z S&L044V- G t /p Atr. 5;RAJ0A= A 24',O/AME7'.ER G'oIyCR�T'�sC•�� = S1dAL L F B�?DU _'. _ 9 CsNT 7-0 61?AO C:O/VGFaCTE h'EAY CAST /RO/Y C O_i�E i4 $i/A r - AIIIV. PITCH Y ^G L. 8E'USE✓O ' /0 0, ELE� 1 r= GOFERS s n - �` I F/IV Dim/•VEl'VA Y aF; YB - Awl w. CC) VER J CL EAN • SANS_ � t/9U/D LEYEL 4"CAST J y o:.�.r.o IRON P/PE J 0 G oOF '�. MIN.P/TCN /G O G. G. L. _ e p. . a o . • • • n o4 p/ST. • • yyASNFD SMNE r %"PON P7_ SePT/C TANfC ®oX o.. t • �? • : . . o . • • a•� d ° c a 8 • s • • • o p o • t. t • •EFFECTIVE o • o pEPTH • • a • a _ bb��45HED STONAl E " ° i o •i • e • s • • • p D v PRECAST SEEPAGE. t _ P/7 DR EQLI/v lNVCKT e'LE✓ATIONS oP r.•s • s . .. s • • �e� D _ �- --- /1VY, RT. AT BUILDING J Gs0 F7 ( FT D/AM_ 1 /p_ �"T. O/f1 A'1. C SEE TX0VL.4TJUN> ` /NGET SEPTIC TANK .- �� FT• = i_ O/J7LET SEPTIC TANKFT. '9 S 7 - GRDuNO /trATER TABLE _ INLET D/ST/4/®UT/ON BOX FT. SECT/Q/V OF 0417LE7-DI57-R/®t/T/ON BOX F7 /NLETSEEPAGiE /�/T, 9�_ .S Fr. .SE�f/AGE O/,SI®O.S.A L SYST.E/►'1 TAQUI.�?!ON SCALE 1 ' DeESIGN' CRITERIA �4 / ` O" Y _ D/A'IENS/oN B , 6 y NUi►9BER OF BEVRooMS —3 A/HENS/AN C FT. G.4R49AGED/5a0s41 uv/r_ SO/L _ S0lL 7-E57 _ TOTAL E3T/MATED FLAd(/ `� C G.4L./D.4Y SO/L TEST #/ SOIL T.EST�#2 (UMBER of SEEPAGE P/T5_ fELEK `517 D' -DATE OF SOIL TEST 40 Z/ 7 Z� S/DF 44-ACHING PER PIT ��3_SV FT. RESUL7`S /WITNESSED BY BOTTOM L.EI9CN/Nfr PER P17�Lo C SQ. FT. _ PERCOLAT/ON RATE At/ _ 3, P-,ml"v'/INCH - T07AL LEACHIA'G AREA _�=� SQ. FT. PERCOLAT/GN RATE�2 MI1V.�lNGH RESERi/ELEi4CfIlNGA,gEr4'_ 7 ck SQ.. FT �F7el4j, o� ROBERT P. No.22162 .o 'P 712 MA/N_S_;r 33 ND.MAIN'S9'- HYANN/3 MASS. so. *rARIWOU N MA6S. �rs'ONAt ENv\ := W,•NOGROIJNO Pt-A7 `R' ElNCOU%VTL— _._O ' e ' _ C/d O L/N,0 1it.ATER JOB ND_�.7 v I �: TOWN OF BARNSTABLE X.,0CATION S7lorl- le IaI SEWAGE # Cl VILLAGE #761--i ASST SSOR'S MAP & LOT ISO- INSTALLER'S INSTALLER'S NAMEF� PRONE NO. Q:Pa laeV;I.,,et�s�''�ri� ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type) � (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER! BUILDER OR OWNER DATE PERMIT ISSUED: , DATE COMPLIANCE ISSUED_„ — VARIANCE GRANTED: Yes_ _—No ___ ` _ _ t :4. . .` `� H�. -�� - , �F, � ��i� 1 �ZL�. y�� 1 _� } DATE: 12/14/99 PROPERTY ADDRESS:,27_Bridel_Path Marstons Mills ,Mass. ------------------------ 02648 On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 1-1000 gallon septic tank. 2. 1-Distribution box. 3 . 2-1000 gallon precast leaching pits . Based on my Inspection, I certify the following conditions: 4. This is a title five septic system. ( 7VCode ) 5. The septic system is in proper working order at the present time . 6. Both leaching pits were dry at the time of inspection. SIGNATURE:,f N a me: ------- 6 7 6 Company: J e.2h_P. Macomber_& Son, Inc . Address:_ Box_66 ___________ 666T Z 4 CentervilleL Ma__02632-0066 Phone:...508 775_3338 a THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Ces:pools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 l i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXI Secretar ARGEO PAUL CELLUCCI DAVID B. STRUH! Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 2 7 Bridle Path Name of Owrwr W. B. Rosenberg ILarstons , Mills ,V14 s 02648 Address of owner: +ft of inspeetaon: 12/ 9, Name of Inspector:(Please Joseph P.Macomber J r . I am a DEPepproved system inspector to Section 15.340 of Title 5(310 CMR 15.000) �,pa„yName: J .P.Macomber Son Inc . MaiingAdd►ess: Box 66 Centervi 11 e ,Mass - 02632 Taeplwne Number: 3 3 3 g 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 inspection. The Inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: r Data: .�4_ The System Inspect shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)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 oKmvlronntettta)Protection. The original should•be.sent tovw system owner and copies sent to the buyer, if applicable,and the approving authority. . NOTES AND COMMENTS ' ill revised 9/2/98 Page Iof11 C,Printed on Recycled Paper ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Bridle Path Marstons Mills ,Mass . Owner. W. B. Rosenberg Data of buPaCtk'n: 12/14/9 9 INSPECTION SUMMARY: Check A, B, C, " A A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 1fi.303 exist. Any failure criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: V_ One or more system components as described in the"Conditional Pass'section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yea,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection;or the septic tank, whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. oUZ) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced - The system required pumphig-more than`four•times a yeardue to broken or obstructed pipe(s). The system wiit-p ss- Inspection if(with approval of the Board of Health): - -- broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(corrtimm4l Property Address: 27 Bridle Path Marstons Mills ,Mass . Owner: W. B. Rosenberg Data of Inspection: 12/14/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _,O 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 IN ACCORDANCE WITH 310 CUR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH lMILLPROJECT THE PUBLIC HEALTKAND SAFETY AND.THE OWHONMENTs WO Cesspool or privy is within 60 feet of 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 HEALRi AND SAFETY AND THE ENVIRONMENT: o4 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the pressf nce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not vaGd).- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Bridle Path Marstons Mills ,Mass . Owner: W. B. Rosenberg Date of Inspection: 12/14/9 9 D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: A10 I have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No / 1/ Backup o4sewage intofeciBty"erneten+connponentdoeito an overloaded orclegged•SA"ressspod. 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 iq+��gib��box above outlet Invert due to an overloaded or clogged SAS or cesspool. Liquid depth in aeaspeo is less than V below Invent or available volume Is less than 1/2 day flow. Required pumping more than 4 times In the last year NOT due to clogged or obstructed pips(s). Number of times pumped A. Any portion of the Soil Absorption System,cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well.- Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy Is lomthan 100 fset but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for -coliform bacteria,volatile organiacompounds,ammonia nitrogen-and nitrate nitrogen. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 1/ the system Is within 400 feet of a surface drinking water supply the systemla-wiWn 200 feet*fttFIbutsr"o•asurfaos drirkiaill w—r•-su►ply•••• - - _ ._ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further inforjnation. revised 9/2/98 Page 4of11 f 1 j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 Bridle Path Mar'stons Mills ,Mass . Owner: W. B. Rosenberg Date of inspection: 12/14/9 9 Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes No , Pumping Information was provided by the owner,occupant,or Board of Health. _ None of the system•components.kswe been poa4mWWaPatJeast two-weeks aadtbe'system hasbaeoascelniwgwwwnl Sow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was Inspected for //signs of breakout. _ All system components,Skcluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on:- Existing information. For example,Plan at B.O.H. _ Determined In the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance Is unacceptable) / 115.302(3)(b)) The facility owoar.(and.^^r gash- H differapt frzaLz wnar)awer&prauddedawith iofnrmatioavn JhA prnpa•mai0t&a ^f SubSurface Disposal Systems. I ' 1 I revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddress:27 Bridle Path Mars.tons Mills ,Mass . ownw: W. B. Rosenberg Date of llns�= 12/14/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: /,0_g.p.d./bedro Number of bedrooms(des i An Number of bedrooms(actual). Total DESIGN flow ��// Number of current residents: 9 Garbage grinder(yes or no):� Laundry(separate system) 1 a or r&:_; If yes,separatsJnspection.required Laundry system Inspected �ieor no) Seasonal use(yes or no):_,� / p Water meter readings,if available(last two year's usage(gpd): S Sump Pump(yes or no): �'�j V7 l/, , Last date of occupancy: - CO M M ERCIALIIN DUSTR IAL- Type of establishment: .40 Design flow: VA sand ( Based on 16.203) Basra of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no0 Non-sanitary waste discharged to the Title 6 system:(as or no)AY Water meter readings,if available: .(� - Last date of occupancy: 64 OTHER:(Describe) 1-4 Last date of occupancy: Al1' GENERAL INFORMATION PUMPING RECORDS and 7jo of information: System pumped as part of ins ection:(yes or no)_ If yes,volume pumped: V gallons Reason for pumping: TYpfi qF SYSTEM Septic tank/distribution box/soil absorption system A4 Single cesspool " Overflow cesspool �T Privy .UO Shared system(yes or no) (if yes,attach previous inspection records,if any) —Ah2 i/A Technology etc. Attach copy of up to date operation and maintenance contract VT- Tight Tank Ala Copy of DEP Approval Other 1411 APPROXIMATE AGE of all components, date installed{if known(•and source of4eformation: Sewage•odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6of11 f ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimsed) Property Address: 27 Bridle Path Marstons Mills ,Mass . owner: W.B. Rosenberg Date of Inspection: 12/14/9 9 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction cast iron�0 PVCll*other(explain) Distance from�rivate water supply well or suction line Diameter� Comments:(condition of joints,venting,evidence of fealwge,•etc.) — Joints appear tight No evidenc.e of leakage_ S EOTIC TANK:_ (locate on site plan) Depth below grader Material of construction:zconcrete42metal f&iberglass��Polyethylene tJ/$the►(explatn) If tank is tnetal,list age M Is.age•confirmed by Certificate of Complianc _(Yes/No) Dimensiont: y d R)A Sludge depth: Distance from top of sludge to bottom of outlet tee ortaffie Scum thickness: Distance from top of scum to top of outlet tee or baffle: i Distance from bottom of scum to bottoni of outlet t e or baffle.-AV How dimensions were determined: S I Comments: (recommendation for pumpin condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert,structuraWntegrity, evidence of leakage,etc.) �ump the septic tank every 2-3 years. Inlet & outlet r P P s a r P i n n_ l a r P _ T.i 4iii d 1 PVPI at the aiitl et i nvert i c fi ft,u nnc i-aahpr Thp f ank i G Strnrtnral 1 ennnrd and chnwc nn Pvi rdPnrP of enkn go GREASE (locate on site plan) Depth below grade: leo Material of construction. #concrete1/NmetaW4Fiberglass4A Polyethylen&Wother(explain) A114 Dimensions: AW Scum thickness: Distance from top of scum to top of outlet tee or baffle: AM Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: �B Comments: (recommendat'on for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Grease trap is not present . • I revised 9/2/98 Page 7ofIt I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propeety Address: 27 Bridle Path Owner: Wilna Rosenberg Date of Inspection:12 nspec ion:12/14/9 9 TIGHT OR HOLDING TANK: (Tank must be pumped prior to,or at time of, inspection) (locate on site plan) Depth below grade: 04 Material of construction WA concrete ±metaWj Fiberglassoi9Polyethylene**other(explain) A Dimensions: �— Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:YesVA NgdJ4 Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) TiRhz Or holding tanks are not =rpepnt R DISTRIBUTION BOX: (locate on site plan) h Depth of liquid level above outlet Invert:�� i i Comments: (note-if level and distribution is equal, evidenoe of solids carryover,evidence of leakage Into or out of box, etc.) Distribution box has onp lntprsl NO avidauce of gAlSd$ car- Ey QVeF . No evi dpnrp of l palraoc ; t6 Qs g>3� A 1 e h9dE PUMP CHAMBER:_,�&4*, (locate on site plan) Pumps in working order:(Yes or No) N Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) ump chamber is not Present , revised 9/2/98 Page 8of11 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Bridle Path Marstons Mills ,Mass . owner: Wilna Rosenberg Date of Irwpection: 12/14/9 9 SOIL ABSORPTION SYSTEM(SAS)2 (locate on site plan,if possible;excavation not required,location may be approximated by non intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: O leaching galleries,number: leaching trenches,number,length: 0 leaching fields, number,dimension overflow cesspool,number: Alternative system: n , Name of Technology: ea& Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to hard boney soil to mer(i „m ganri b[. ; Rns of hydrniil i r nfi l i,rc nr n.,ad g rg9 �f3 Q Q v "y . V e g'e�_s-_r9(- CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: 14 Depth of solids layer: 414 Depth of scum layer: 1414 Dimensions of cesspool: W Materials of construction: 414 Indication of groundwater: A inflow(cesspool must be pumped as part of inspection) Cesspools are not nrecant Comments: (note condition of soil, signs of hydraulic failure,.levei of pending,condition of.vegetation, etc.) Cesspools are not present . PRIVY:i (locate on site plan) Materjals of construction: A/9 Dimensions: /UA Depth of solids:�i� Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present . revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Bridle Path Marstons Mills ,Mass . s ;« owner,: Wilna Rosenberg .:.t Date of Inspection: 12/14/9 9 41 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks "! Ipcate all wells within 100'(Locate where public water supply comes Into house) a Y: rx. r \ ArIJ-e �f \ Q:7 revised 9/2/98 Page ioorn e SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C SYSTEM WFORMATION(continued) PropertyAddress:27 Bridle Path Marstons Mills ,Mass . owner: Wilna Rosenberg ""Pe":I"spe`no": 12/14/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater l�r�� Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed. 8.(Abutting propo bservation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Water Contours Map . Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11of11 r a•.rrT nl.-ntrR�•rrrnranr•n1.T.s�nrt+srRlntrlr+l+�rN�.l+�*./T eRAU A�7►'�rlsTl '�� TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE I)ISPUSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION «ern«r•••;..—r1lrm.-r M mn_n.�rn�eerrrrrrrr.�-.t�rtve+r� t �.n v.+rrr•r.-ter—..� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 27 Bridle Path Marstons Mills ,Mrass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Wilna Rosenberg PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomber & Solf 'Inc . COMPANY ADDRESS Box 66 Centerville ,Mass. 02632. Street Town or City state LIP COMPANY TELEPHONE ( 5081 775m - 3338 FAX (508 ) 790- 1578 a A• CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete 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 , • i i III:{i 1, Check one: one: Y 1� S steui 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 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have con acted 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. "r d AAL� Inspector Signature Date copy of :his certification must be provided to the OWNER, the BUYER o.ne6 here applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or""operator shall upgrade ' the system. within o'ne year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd.doc