The URL can be used to link to this page

Home My WebLink About0046 ROUTE 149 - Health +5 ROUTE 149, MARSTONS MILLS Town of Barnstable Health Inspector oFt t Office Hours do Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 • snaivsrnBM • Public Health Division ArEor s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: B� I Address: 1 Map 7 7 Parcel Name: 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? &�o If yes, how many? 2c. How ma y be rooms total are proposed at this property (including the amnesty unit)? Pr bp- 2d. Please include a copy FffloApaTortenire ror showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or NO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? :; YES r NO 8. Is there an engineered septic system plan on file at the Health Division? YES or; NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES 43 NPO ------------------------------------------------------------------------------------------------- I ------ FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: A—7 Q;/health/wpfiles/amnestyapp • J 3 x-7 04 1___`�- 1 l k Z ZI i � � �� /` - �; tt�� .�� ,�._ ��s�� . � � � 1.� �.(.�� _ .. ��e� l � �1 `� � �' � SUBSURFACE SEWAGE DISPOSAL SYSTEM,WSPECTION FORM f +< ` PART C SYSTEM INFORMATION h press: 46 Route 149 Marstons Mills,Mass . M� owr,e. Joan A, McAuley "to of Inspection:3/6/0 0 Flow coNDrnoNs �,.. RESIDENTIAL: { Design flow: ik g.p,d./bedr m. Number of bedrooms(des! ) Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) as or�_ If yes, separatelnspactlon.required Laundry system Inspected a or no,) Seasonal use(yes or no): e / Water meter readings,If available (last two year's usage(gpd): 7 O l Z n � �G 4/,-OF Pump (yes or no): � Last date of occupancy: COMMERCIALMIDUSTRIAL: Type of establishment: Design flow:_) _ apd ( Based on 16.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no)AM Non-sanitary waste discharged to the Title 5 system: (yes or no),fo Water meter readings,If available: - Last date of occupancy: OTHER:(Describe) L�IS Last date of occupancy:_ GENERAL INFORMATION PUMPING 1 C Dl sour cg o�nf a System pumped as part of inspection:(yes or no),&D 7 If yes, volume pumped: gallons Reason for pumping: TYPE OF,Sptic _/Septic t • tank/distribution box/soil absorption system Single cesspool Overflow cesspool _ Privy Shared system (yes or no) (if yes, attach previous Inspection records,if any) UA Technology et Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed{if known)-and source ot4nformation: Sewage odors detected when arriving at the site: (yes or no)� revised 9/2/98 Page 6of11 e. .3/6/00 DATE'- --- ` '�> gPtADDRESS; t�_-----e--1�----------- rMarstons Mills�Mass - ----- -- ---- 3 _ -------------- ----- On the above date, I Inspected the septic .system at the above address, { , Is-.system consists of the following: f1Q0 �ga11'on septic tanks. piFstribution box. ,eac'. field 23 'x16 ' Approx. Y{ [ nr�xf✓' F Based on my Inspection, I certify the. following conditions: a title five septic system. ( 78 Code ) ._ TS.. he septic system is in proper working order / Q at the present time. further Evaluation By The Town Of Barnstable # ,94PEr6ard Of Health., r '7 TYie leaching field is less than 50 ' from the river. 27 off river. �x SIGNATURE; N �xr Name: _ios.4mtrr- ------ Company: Jose�h_P. Macomber Son ,Son , Inc . RECEIVED Address; Box 66 ------------------- klAk z 1 2000 --Centerville , Ha_-02632-0066 TOWN OFBARNSTABLE HEALTH DEPT. Phone: 508-775-3318 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P, MACOMBER & SON, INC, Tan ks-Cesspools-Leichflelds Pumped & Inst:liod Town Sswor Connectlons P.O. Box 66 Centerville, MA 02632-00.66 775.3338 775.6412 jHE r Town of Barnstable BAMSTABLE Department of Health, Safety, and Environmental Services "3 i639• Public Health Division �� 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 FAX: 508-775-3344 Thomas A.McKean,RS,CHO Director of Public Health March 22, 2000 J.P. Macomber, Jr. Joseph P. Macomber& Son, Inc. P.O.Box 66 Centerville,MA 02632 RE: Septic Inspection, 46 Route 149,Marston Mills, MA 02648 Dear Mr. Macomber, The Barnstable Public Health Division received a copy of the Septic Inspection Report, dated March 6, 2000, for the above referenced property on March 21, 2000. The septic Inspection Report indicated that the category "Needs Further Evaluation by the Local Approving Authority" (Section C (1) +(2))was checked. After review of the Septic Inspection Report, further evaluation by the Town of Barnstable Public Health Division has concluded that: • The leaching field is considered a soil absorption system (SAS) and not a cesspool or privy. Therefore, section C(1) does not apply. • The "river"mentioned in the Septic Inspection Report is a;watercourse draining from Mill Pond to Prince Cove known as the Marstons Mills River. The Marstons Mills River including Mill Pond are not a tributary to surface water supply or a surface water supply. Therefore, section C (2) does not apply. Therefore,the septic inspection.report should be revised with a conclusion of"PASS". No further evaluation is necessary or required. omas McKean., R.S., C.H.O. Director of Public Health cc: Joan A. McAuley FTNE Town of Barnstable saxivsrnsts Department of Health, Safety, and Environmental Services 9� NAM ,• Public Health Division ArEo �s 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health March 22, 2000 J.P. Macomber, Jr. Joseph P. Macomber& Son, Inc. P.O.Box 66 Centerville, MA 02.632 RE: Septic Inspection, 46 Route 149, Marstons Mills, MA 02648 Dear Mr. Macomber, The Barnstable Public Health Division received a copy of the Septic Inspection Report, dated March 6, 2000, for the above referenced property on March 21, 2000. The septic Inspection Report indicated that the category"Needs Further Evaluation by the Local Approving Authority" (Section C (1) + (2)) was checked. After review of the Septic Inspection Report, further evaluation by the Town of Barnstable Public Health Division has concluded that: • The leaching field is considered a soil absorption system (SAS) and not a cesspool or privy. Therefore, section C(1) does not apply. • The "river"mentioned in the Septic Inspection Report is a watercourse draining from Mill Pond to Prince Cove known as the Marstons Mills River. The Marstons Mills River including Mill Pond are not a tributary to surface water supply or a surface water supply. Therefore, section C (2) does not apply. Therefore, the septic inspection report should be revised with a conclusion of"PASS". No further evaluation is necessary or required. omas McKean., R.S., C.H.O. Director of Public Health cc: Joan A. McAulev DATE: .3/6/00 P R O P E R T Y A D D R E S S:_4.6._Routes 1�__________ Marstons Mi11s1Mass____ -------------- On the above date, I Inspected the septic system at the above address. This .system consists of the following: 1 . 2-1000 gallon septic tanks. 2 . 1 -Distribution box. 3 . 1 -Leaching field 23 'x16 ' Approx. Based on my Inspection, I certify the following conditions: 4 . This is a title five septic. system. ( 78 _Code ) 5. The septic system is in proper working order at the present time. _ -= 6 . Needs further Evaluation By _The_ Town Of Barnstable Board Of Health.. 7:"The leaching field is less than 50 ' from the river. -27 ' off_ river.__ SIGNATURE:.f Name:_,La,-Aps.slat.gr-JL�------ Company: Jose.Rh_P_ Macomber & Son , Inc . RECEIVED Address Box_66 MAk Z 1 2000 --- ------- Centerville � Ma__02632-0066 TOWN OFBARNSTABLE ---------- "— HEALTH DEPT. Ph one: 508 775_3338_______ THIS ;,ERTIFICATION oOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachflelds Pumped & Installed Town sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775.6412 i r } COMMONWEALTH OF MASSACITUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRATECTION ONE WINTER STREET, BOSTON MA 02108 (817) 292.6600 TRUDY C Sacr ARGEO PAUL CELLUCCI DAVID B. STR Governor Com:ai. SUBSURFACE SEWAGE DISPOSAL SYSTEM—INSPECTION FORM PART A CERTIFICATION PropwTyAddrew: 46 Route 149 M&M NaawOfOv,.W Joan A. McAuley Marstons Mill sa Mass. AddrsofOwrwr: 10 remon Street Dauof�e'ction: 3 6 60 APT;301 Boston,Mass. 02111 Haan of Inspector ( Print)Joseph P.Macomber Jr. I am a DEP oved system in a inspector pursuant to Section 15.340 of Thfe 6(310 CUR 15.000) or cnpeny Nanw: J.P.Macomber & Son Inc. ►rtaa'ng Addre": 02632 T4eph4rw Number: — — CERTIF1CAnON STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the Information reported below Is true, accurst@ and complete as of the time of Inspection. The Inspection was performed based on my training and Wsr(snce In the proper function ►no maintenance of on-she sewage disposal systems. The system: •-• Passes _ onditionally Passes Beds Further Evaluation By the Local Approving Authority~ _ Falls - - — Jj V.H>ectoes Skywrture Darts: ��CJ The System Inspe r shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)wWn thirty (30) days completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Irspettor and the system owr fish submit the report to the appropriate regional oMca of the Department vKmvironmattld Protection. The original should Ue sent town system owner and copies sent to the buyer. If applicable, and the approving authority. NOTES AND CONWENTS Needs further evaluation by the Town Of Barnstable Board Of Health. - `.__`` Reason for this is that the leaching field is less than fifty feet from the river. It is 27 . away- from- the river. " The system is in, proper working order at, --the- time. revised 9/2/98 PailtIofII `�►rintd on ttegcid Isper SUBSURFACE SEWAGE DISPOSAL SYSTBA INSPECTION FORM r , PART A CERTIFWATION(oondrwed) Property Address: 46 Route 149 Marstons Mills,Mass. own - Joan A. McAuley Dee of lr►:pKwn: 3/6/0 0 INSPECTION SUMMARY: Check A. B, C, or D: A. SYSTEM PASSES: I have not found any Information which Indlcates that any of the failure conditions described In 310 CMR 4.303 exist. Any faaws criteria not evaluated are indicated below. eta Ts: The leaching field is within 27 ' of the r; rar B. SYSTEM CONDITIONALLY PASSES: One or more system components as described In the 'Conditional Pass'section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not datermined(Y.N,or ND). Describe basis of determination In all Instances. If 'not determined',explain why not. A+ 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 exNvation, a 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. Sewage backup or breakout or high static water level observed In the distribution box Is dus to broken or obstructed pip*w or due to a broken, settled or uneven distribution box. The system will pass Inspection If(with approval of the Board of Health). broken plpe(s)are replaced obstruction Is removed distribution box Is levelled or replaced - The system fsquired pumping-mm Ow-iour•tfines-a•yeardue to broken or obstfoeted plps(s). The tyst*tn will van— Inspection If(with approval of the Board of Health): broken pips(s)are replaced obstruction Is removed revised 9/2/98 page zorit i r INSPECTION FORM SUBSURFACE SEWAGE DISPOSAL SYSTEM PART A CERTIFICATION Iconthx+ed) P.openyAd&*-: 46 Route 149 Marstons Mills,Mass. Owner: Joan A. McAuley Date of Inspection:3/6/D 0---—--- -— C.,/FURTHER EVALUATION 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CHAR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.yALL.PRaTECT THE PUBLIC HEALTHAND SAFETY AMD THE Bi11080NMENT- _ Cesspool or privy is within 60 feet of surface water cesspool.or..privy is within 60 feet of a bordering vegetated wetland or a salt marsh. Leaching field is within 27 ' of the river. 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 AND SAFETY AND THE ENVIRONMENT: YThe 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 hasaseptic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. Al The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well. /W The system has a septic tank and soil absorption system and the SAS is less then 100 feet but-60 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance W-4 (approximation not va4d). 3) OTHER revised 9/2/98 Page 3of11 r , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coroinued) Property Address:46 Route 149 Marstons Mills,Mass. Ownw: Joan A. McAuley Date of Inspection: 3/6/0 0 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: _ II have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this --�determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No , Backup of•sewegs irrtofecili"-etetem component duo%to an overbaded orelegged SAS-or-cssspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level In the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool Is less than 6" below Invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System,cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone I of a public well. Any portion of a cesspool or privy Is within 50 feet of a private water supply well. f� 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 analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria, volatile organic.compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes !/No / the system Is within 400 feet of a surface drinking water supply the system-i:FwitWin 200 festof♦t+ir�uterytoeaurfeoedrir►kiwQwater+ulaplY _ ' -." _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412). Please consult the local regional office of the Department for furher Inforpation. revised 9/2/98 Page 4of11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART B CHECKLIST Property Address: 46 Route 149 Marstons Mills,Mass. Owrw: Joan A. McAuley Date of Insp.cdon: 3/6/0 0 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 systemcompoaants wamoimen pumped4w-acJeasttwotwee144aadtbe'aystem h"j;&wv*eaisaiag"Somw flow 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,44luding 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 andi location of the Soil Absorption System on•the 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.)I The facility cwnw(and.ocru-pants,If differaztt from.mmow),wara-prauidad.w)th Infa n"oman Ilt-P apor msin*aa-Ma of SubSurface Disposal Systems. revised 9/2/98 Page Sof11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Route 149 Marstons Mills,Mass. owner: Joan A, McAuley Date of Inspection:3/6/0 0 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d.lbedr m. Number of bedrooms(desi ) Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) es or _ If yes, sepamte Inspection,required - Laundry system inspected s or no Seasonal use(Yes or no): 9 !4 �� Water meter readings,if available(last two year's usage(gpd): , Sump Pump(yes or no):_620. Last date of occupancy: COMMERCIAL/INDUSTRIAL: n Type of establishment: IVA Design flow:__1 sad ( Based on 16.203) Basis of design flow AM Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no).,iy Non-sanitary waste discharged to the Title 5 system:SSyes or no)9)A Water meter readings,if available: A4 Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING FECD �d source,�nf System pumped as part of inspection: (yes or no),0 if yes, volume pumped: gallons Reason for pumping: TYPE"STEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous Inspection records,if any) IlA Technology etg. Attach copy of up to date operation and maintenance contract Tight Tank 10 Copy of DEP Approval Other ti� APPROXIMATE AGE of all components, dots installed.lif known)-and source of4nfermationc /V Sewage odors detected when arriving at the site: (yes or no),d2 revised 9/2/98 Page 6oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress:46 Route _ 1 49 Marstons Mills,Mass. Owne<: Joan A. McAuley Date of Inspection: 3/6/O 0 BUILDING SEWER: (Locate on site plan) Dept below grader v Material of construction:�sast iron�0 PVC bother(explain) Distance from private water supply well or suction line _ Diameter _ Comments: (condition of joints, venting,evidence of leaka9e,-9tc.) - Joints appear fight Nn pxri rlpnce of leakage. s C TANK: 1010 A; /,� vent. (locate on site plan) d Depth below grade: Material of construction: oncreteN�metal,j)�Fiberglaas N�Polyethylene_other(explsin) N If tank is metal, list age Al2 ls.age.confumed-by Certificate of Compliance 41,4(Yes/No) Dimensions: Sludge depth: .i is Distance from top of udge to bottom of outlet tee ortaffle �,�r+� Scum thickness: �� Distance from top of scum to top of outlet tea or baffle:�� Distance from bottom of scum to bottorp of outlet tee or baffie:-Allul,Q- How dimensions were determined: Comments: (recommendation for pumping,condition_of,inlet and outlet toes.or.bafflas,•depth of liquid level in relation to outlet invert, structuroHntegrity, evidence of leakage, etc.)VPUnn tankeevery 2-3 years Tnl et & niitlpt f Ppq arp in p1 are The I i Glib 8 1 pVPI at tha niit l lS f i ity gFiA i A6];Bgr`P13AteZI;k GREASE TRAP: (locate on site plan) Depth below grade:, Material of constructionyl/�J concreted,*metal4?±Fiberglass4)h Polyethylen&ttother(explain) Dimensions: APY Scum thickness: 444 Distance from top of scum to top of outlet tee or baffle:A�d— Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) C pr'3gp trap is not nroseni- revised 9/2/98 Page 7orn i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contimmd) Property Address: 46 Route 149 Marstons Mills,Mass. Owner: Joan A, McAuley Date of Inspectl4m: 3/6/0 0 TIGHT OR HOLDING TANK:66e (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grsde:A, Material of construction:,tAconcretellmetal42Fiberglass /�Polyethylene��other(explain) AA Dimensions: Capacity: AM gallons Design flow: AM gallons/day Alarm present Alarm level: Alarm in working order:Yes NoZw Date of previous pumping: ,AJW Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight Or holding tanks art- nni- x@SBnt. DISTRIBUTION BOX:/ (locate on site plan) 1 Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidenoe of solids carryover, evidence of leakage into or out of box, etc.) — — PUMP CHAMBER:i,&/L (locate on site plan) Pumps in working order:(Yes or No)�� Alarms in working order(Yes or No)_ iQ Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) PumR chamhPr is nnf- "resent revised 9/2/98 Page 9of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEIA INSPECTION FORM : PART C J SYSTEM INFORMATION(contirx.d) PropwtyAddrass: 46 Route 149 Marstons Mills,Mass. owner: Joan A. McAuley Data of 4,spection: 3/6/0 0 J SotL ABSORFTION SYSTEM(SAS)- (locate on site plan,If possible;excavation not required,location may be approximated by nondntrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,numboj loathing galleries,number: leaching trenches,number,length:� 7xlf/ leaching flelds, number, dime Ions: L� overflow cesspool,number: Alternative system: Name of Technology: rpitlTe Five 78 Code. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, Ste.) Loamv sand t O signs of hydrauiic failure or nnnrli ncl qni 1 c arc Ary Vegetation is nnrmal CESSPOOLS:11 (locate on site plan) Number and configuration: Depth-top of liquid to Inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of Inspection) • Cesspools are nnf- present - Comments: (note condition of soil, signs of hydraulic fallure,.level of ponding,condition of+vegetation,etc.) esspoo a are not present - PRIVY:/Abtx, ' (locate on site plan) / Materjals of construe on: ///� Dim@nalons: Depth of soUds: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy revised 9/2/98 Psgt9of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C # It ; SYSTEM INFORMATION(con*vjod) Prop.MAdd,"a:46 Route 149 Marstons Mills,Mass. Ownw: Joan A. McAuley Daze of Inspection: 3/6/0 0 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) !2, i r / � 11 23 t � �3a revised 9/2/98 Page 10ofIt I y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ( • ' > r SYSTEM INFORMATION Icontimsod) PropertyAddr"s: 46 Route 149 Marstons Mills,Mass. Owner: Joan A. McAuley Data of Inspection: 3/6/0 0 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 i Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, bservation hole, asemeat sump etc.) Cetermined from local conditions hecked with local Board of health Checked FEMA Maps Z' 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 11ofIt (. •TT{T.�R 1'R�TT�\TR�J..f•RTiRRf"TIf 7TT.fTl1.t•.TTT1.►fwf�.I..'\AtTt7i Rfl7}�,Rt. _ 1 TOWN OF Barnstable - ` BOARD OF IIEALTII S011SU11FACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CBR'1'IFICATION I •••T••1�T••.•.•!-�.tT.^.�T.T.T.T'ff.'1TI TA1riC!\ffR'7!T'T.•.'fr'11RR,7Rfl7'TT/IRA►R1�fRIt�R�'IR7 7nRR ..tr•P1^'T`•�• -..w -TYPO 01 PRINT CI.EARLY- PROPERTY INSPECTED 46 Route 149 Marstons Mills,Mass. STREET ADDRESS ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME ,loan A. MgZulev PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Stfi Inc. COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City State LIP COMPANY TELEPliONE ( 508 ) 775 - 3338 FAX (508 ) 790r 1578 RI 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 witli my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check ne : Z-7System _PASSED --Needs further evaluation by the Town Of , Barnstable Board Of Health. 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 tcted has found that the system fails to Protect the ilublic health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signatur Date 'zoz _ . ne copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF HEALTH. * If the inspection FAILED, this owner or..°o^operator shall u P pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3,10 CMR 16 . 306 . partd .doc f72 L0'CLA T I�N rr AGE PERMIT NO. A CFO VILLAGE ark'- 4>47y INSTALLER'S NAM & ADDRESS BUILDER OR OWN DATE PERMIT ISSUED �73 _ -� OAT E COMPLIANCE ISSUED w '� I G�.� � i �� a9�G'�---a'� s � �� \� � I 1� •� ��f � 1 -• ' RTF 10 cola C.'o46 4 W) ft'lls �I �i i1 23' i .:a Joan A. McAuley 46 Route 149 Marstons Mills,Mass. 2-1100 gallon septic tanks. 1 -Distribution box. 1 -Leaching Field 23 ' x16 ' Appox; No. ... F�s.....V`.-`.................. THE COMMONWEALTH OF MASSACHUSETTS BOARDl(E HEALTH ......OF....................' ---p" 1. /�/J/2.....,...._.. Appliration for llispmial Works Tomitrnrtinn thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: � ................__...-.....--- ...---......_..---..........._...--•-••••••--••••--•-•---••----- --•---•----•------•-----•-----•---••-•----•-•--------•.....-----•----•-•-••--••. ••----•--•-•- Locat• n-Address No- . . . . . .:.............................•••-••__ ..................................................... = ---=-------.... owner > A ress W t � _ [, ,., ----------- - --- __ _-:_-. -c- ---------------------------- .............................. ...... .._. =.._--- .. - Installer Address d Type of Building� Size Lot............................Sq. feet Dwelling— o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............................. No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ....--•--•-----•--•----••-----•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter---------------- Depth_•_-__________.- x 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 ( ) .-a Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_______________________. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. O Description of Soil......... --•-------------•---••-•-•--•---•-------•----....------------------------------------------------------------------....._...----- ------- ------- -- ------------------------------------------------ ------------------------------*--------------------------------- W •••------••-•--------------••---•••----•••-•--•-••----------•••••-•-•--•--••---•-•••••-------•--•-------•••-••---------...----------------------- .. --- -------------- ------ UNature of Repairs o~ Alterations—Answer w n applicable.._ �__ _ ... '- :._.__ /�? -------- _.-.._._ ............. - •-•- Agreement:The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:T'T L y g g p y S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ined- ----- ---••---•--•---•-----•---------••--•••------•----- -•---•------•-•-••-••--------- Date Application Approved BY //Clt,: -- " c .......... Date Application Disapproved for the following reasons------------------------------- -----------------------------------------------------------•---•---------------- •----•.......................•-•--------....-------_._._._...---------_...-------------•--•--------•-•----------•-------•--•-•-•-------•-•••---•---•--•-•-•-•--•---•---------------•••••••-----------•- Date PermitNo......................................................... Issued--•- -----------------------------------------•-_----- Date No......................... ~ FIME......................'.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH - ....... ..........OF.... : 'Z! 1 :................ Appliration for Dhipuiial 19orkii Tonstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( PT an Individual Sewage Disposal System at: f................ ..... ------ -•--••---•-- --------- Locati0n-Address a PA,f. ..... ...................................... - f .,.....� a_.... •- .... ---- rOwner / Address /_ fit % ils, Installer Address UType of Building'' Size Lot___________________________Sq. feet Dwelling�'No. of Bedrooms______________________________--------_-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons-------_.................... Showers ( ) — Cafeteria ( ) p-' Other fixtures _________________________________ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid*capacity------------gallons Length................ Width-----------_--- Diameter---------------- Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................___ Total leaching area....................sq. ft. 3 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______________________.. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4------------ DDescription of Soil::__�_''��----------------------------------••--------------------------------------------------------------------------•-------------------. V -•••••-•---•--------•-••--•-••--------•--•--•••-•--•----•••-•---------------•--•----•--•------•---••-•---•••-----------•••-•--•---•••••-••-------------------------•------...--•---•---•--•--••---••--- -, UW ----------------- ----- Nature of Repairs Alterations—Ans er wen applicable.____ :mod""__ _____. f ................... Agreement: k The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ii:L p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. 'Signed/-•---.J-------= '--••------••••._._......•------------------------=-----------•--- ............................... V ,y- Application Approved By......... - --------------- ��( "` 1•_`_'3 Date Application Disapproved for the following reasons-------------------------------•----•------------_..--------------------------------------------------........_ --••................••---•--•------••-------•------•-------------•------•-•-----------.......-------•---•..--------------------------•-------•----------------=----•---•.......................... Date PermitNo......................................................... Issued....................................................... Date ,. THE COMMONWEALTH OF;MASSACHUSETTS i BOARD O H,EALTH ........... .....�..OF........... ..... .... ............................................... 4 �rr�ifirtt#le ,af fP��a�t�r�i�nrr �,,,. THIS S TO CER�Tl Tj`h Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ,� .. ...............•-•-•- -- -----------------------•--- -----••----------•------------ ,j/ f / Installer at.- - ------•---•-•••------••---•- •-•- •- has been Installed m accordance with the provisions of I o he State Sanitary C9de de• ed.in the, application for Disposal Works Construction Permit No----- _______________________________ dated._..._/_........................................ THE71SSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM, WILL FUNCTION SATISFACTORY. DATE............................................ ..... _Inspector. THE COMMONWEALTH OF MASSACHUSETTS ..- BOARD fO HEALTH ............. . No...... r� FEE..:....................: Dispo V �yn''r/fk�� n Idr / ton amit Permission ' ereby grant - • ---•••-_....----••• ----.•-••- ••-- ..................................... to Constru or,Re n Individual Se e I / Y t e ! r ` Street J� jr, as shown on the application for Disposal Works Construction P it N __________ ___i Dated_ / _ J . ....--------Ll / Board of Health DATE.../` ............................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS LIU CoAt Pq Ca �4- M) K4 v- 6 C-41 SQ to lc4 tT r to s� co