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HomeMy WebLinkAbout2723 MAIN ST./RTE 6A(BARN.) - Health 2723 Main Street/Rte I A�", Barnstable P 258 039 i t f f 0 k � � © � � � � � 1� n7 � � � � � � � � - '" � � --� � � Q � `.� � ,�� �' v � � © � � � � � � � � � I �� O �� a - - - O - � _ O C r J 11 o .. ���. d. j. TOWN OF BARNSTABLE LOCATION SEWAGE VILLAGE /rt ASSESSOR'S MAP & LOT* 5�' 03 / INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER c ! " DATE PERMIT ISSUED: -I `� �i rzrS �h DATE COMPLIANCE ISSUED: �b a OrJ"r VARIANCE GRANTED: Yes No x 1 _� s t� .15� W � Iai T� ca a i i I o I t_ r - COMMONWEALTH OF MASSACHUSETTS { EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION . c /U 0, aS N ASSESSORS MAP PARCEL NO' TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION J Property Address: 2723 Route 6A,Barnstable,MA 02630 RECEIVE® i Owner's Name:Joan Lagraw �J U L 1.5 2004 Owner's Address: 110 Allyn Lane,Barnstable,MA TOWN O B NSTABLE Date of Inspection: June 18,2004 Name of Inspector: REED C.ELLIS . P Company Name: ELLIS BROTHERS CONST.CO. Mailing Address: 23 ENTERPRISE ROAD, P.O.BOX 59,YARMOUTH PORT,MA 02675 Telephone Number: 508-362-6231 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: XaSonallyPassesurther Evaluation by the Local Approving Authority is Inspector's Signature: j Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: Q� J V O I have not fo d any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: Alk One or more system components as described in the"Conditial Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the fo the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or th septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available ND explain: Observation of sewage backup or break out or high i atic water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distr bution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are repli red obstruction is removed distribution box is leve ed or replaced ND explain: The system required pumping more than 4 times a y ar due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are repla obstruction is removed ND explain: 2 r Page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 C. Further Evaluation is Required by the Board of ealth: Conditions exist which require further evaluation y the Board of Health in order to determine if the system is failing to protect public health,safety or the environme rit. 1. System will pass unless Board of Health detern iines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which W 11 protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bord ing vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(ani I Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorpi'on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface watc r supply. _ The system has a septic tank and SAS and th SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and th SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and th SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to dete ine distance "This system passes if the well water analysis,p rformed at a DEP certified laboritory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analys s must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:2723 Route 6 A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes N ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ischarge 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 — t�o!uired pool id depth in cesspool is less than 6"below invert or available volume is less than'/day flow R pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Zy es pumportion of the SAS,cesspool or privy is below high ground water elevation. A)iortion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface a supply. py ortion of a cesspool or privy is within a Zone 1 of a public well. Anyortion of a cesspool or privy is within 50 feet of a private water supply well. portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] w(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary t correct the failure. �e S E. La stems: Y To be considered a large system the system m t serve a facility with a design flow of 10,000 gpd to 15,000 1Tth You must indicate either"yes"or`no"to each of t ie following: (The following criteria apply to large systems in a(dition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply — the system is within 200 feet of a tribut to a surface drinking water supply — the system is located in a nitrogen sensit've area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Sect on E the system is considered a significant threat,or answered "yes"in Section D above the large system has fail .The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CUR 15.304.The system owner should contact the appr riate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 Check if the following have been done.You mast indicate"yes"or"no"as to each of the following: Yes N mping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out Were all system components, luding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of t baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Veno — Existing information.For example,a plan at the Board of Health: Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)], 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4/1O DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). -T Number of current residents: Does residence have a garbage grinder(yes or no): A O Is laundry on a separate sewage system(y or no):�b[if yes separate inspection required] Laundry system inspected(yes or no):=�'4 Seasonal use:(yes or no): //O Ov � �l Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Ala Last date of occupancy: zLe-I& 04 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): /Y GENERAL INFORMATION . Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped lions--How was quanti limped determined? Reason for pumping: e?e, �� � —�� TY OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool .— Privy - _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the currant operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximatt.ag�ofalll omponen date installed(if own)an4 source of informa ion: Were sewage odors detected g when arriving at the site(yes or no): 6 f Page I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 BUILDING SEWER(locate on site plan) Depth below grade: z741 Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments f on condition of joints,ventigg,evidence of Ieakage,etc.): L sii.� r n��i� Za &A ko SEPTIC TANK: t' locate on site plan) Depth below grade: C;V y L't/ O►• f `�Y2 7�;- Material of construction::j�concrete_metal fiberglass Polyethylene other(explain) tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of ` certificate) r Dimensions: k S k Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet t9e or baffle: O. . How were dimensions determined: rW Comments(on pumping recommendatiofis,inlet and outlet tee&baffle cd6ditioVstructural integrity, liquid levels as related� ut}et invert ev}d of I ge etc.): GREASE TRAP: (locate on site plan) ) Depth below grade:— Material of construction:_concrete_metal_fi lass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or ale: Date of last pumping: Comments(on pumping recommendations,inlet and out et tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page$of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 TIGHT or HOLDING TANK: (tank must be pumpt J at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fibe glass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): _ Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: /JV Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of' leakage into or out of box' c.): oy449+ v CA DWA, N9 1a A<4 PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition ofpumps and appurtenances,etc.): 8 I , Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 SOIL ABSORPTION SYSTEM(SAS):-(locate on site plan,excavation not required) If SAS not located explain why: Type aching pits,number: leaching chambers,num_ber: �. 3 3 O � Ctkt' ago leaching galleries,number: �^`L g leaching trenches,number,length: �� `� 'q "-j leaching fields,number,dimensions: overflow cesspool,number: innovativetaltemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): , �o tia Via mug le 1V114- CESSPOOLS: (cesspool must be pumped as part of if spection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation,etc.): All, PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic fail level of ponding,condition of vegetation,etc.): 9 Page i 0 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM_ INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 rr•• SKETCH OF SEWAGE DISPOSAL SYSTEM S Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. 47 HU N N Nti Nr'n — 'c.,O � W �N 1,10 O P td, 'ac,rl�� \ 0 10 37 e•3 33 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 SITE EXAM Slope l Surface water `�✓ f' s.0 7�ie..w# -f-# A&IAy f�Lo 117 11GA k Check cellar- Shallow wells Estimated depth to ground water//7-feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within ISO feet of SAS) ecked with local Board of Health-explain: hecked with local excavators,installers-(attach documentation) Accessed USGS database-explain: Chi'__ G%t���GG Ap1j s You must describe how you established the high ground water elevation: J*J 5 14 �JV4 r�di5-- C- -r 0 PLA + (v7 ,� 1 1 i l j - f i Septic Inspection Information Data.`.... 1ate ¢.'"c i35'eel Nti ...;>;>; Y;::.........: 9/21/2004 f P 2247 s ess rs iVEaip; 258 4 —� t'ar..::::.1.::: 039 l©t >ier 27231dir ee e l� .. lBarnstable ...................... IReid C. Ellis ct;#ale G5t@f .... :: :.;:.;:.;.;<:; 7/2/2004 ......:....................:. P . .................. .................Cf3tS': Septic system is designed for 3 and there are only 3 bedrooms Per Thomas Mckean Health Dept erlFr � Repair;Hate:: > > �l3cat + atie >)"t3`l3't;�lier epr> eadlJpTf e Joan M. LeGraw Attorney at Law 110 AQyn Lane Barnsta6[e, Massachusetts 02630 E-max(J.[egraw@verizon.net (508) 375-0367 Fax (508) 362-0226 September 212004 Mr. Thomas A. McKean Department Head Board of Health 200 Main Street Hyannis, MA RE: Septic Inspection dated June 18, 2004: 2723 Main.Street, Barnstable (Assessors Map No 258, Parcel No, 039). Dear Mr. McKean: This letter in intended to dispute.the accuracy of the Title 5 septic inspection report filed on July 2, 2004 by Reid C. Ellis, Ellis Brothers Construction, Co. (the"Ellis Report"). The inspection of my property at 2723 Main St., Barnstable MA,was performed on June 18, 2004. The inspector checked"System Passes"on the 2"a page of the form and there were no other deficiencies noted in the septic system. Nevertheless the front page Certificate Statement reflected that the report"needs further evaluation by local approving authority." Apparently this was checked by the inspector because of an error in the calculation of the number of bedrooms in the house. The report states that the house has four bedrooms. If this were true then the septic tank is not large enough. However this is a three bedroom house and it has always been a three bedroom house. Upon receiving notice of the Ellis Report I called your office and spoke with Ms. Donna Marundo. I asked her what was involved in the"further evaluation"of the Board of Health as required by the report. Specifically, I asked her if an employee from your department would look at the house. (It would be immediately apparent to anyone viewing the property that a mistake had been made in the calculation of the number of bedrooms.) However, I was told by Ms. Donna Marundi no one would come out to the property and that in order to contest-this report.I would have to submit my own evidence to support my claim that the Ellis Report is inaccurate. In that regard, I submit the following facts.to prove that this house is a three bedroom house: r i 1. The diagram on page 10 of the Ellis septic report in inaccurate. There is NO bedroom in the spot designated as bedroom 1. There is NO bathroom attached to the room designated as Bedroom 1. The report also fails to indicate that the sole entrance to the basement (a vented door) is located inside the room designed as bedroom 1. This is clearly not a room"primarily intended for sleeping",as per the regulations. 2. An accurate floor plan is attached hereto as Exhibit A. This floor plan was drawn by Paul McDowell, a registered septic inspector. I asked Mr. McDowell to view the house and sketch the inside of the house at 2723 Main St. Specifically, I asked him to locate and identify the interior rooms as required for a Title 5 inspection pursuant to 310 CMR 15. 3. As this sketch indicates there are three (3)bedrooms in the house. The first floor bathroom is located next to the only bedroom on the first floor. (In the Ellis Report the location of this bathroom is totally wrong.) 4. The definition of a"bedroom" in 310 CMR 15.002 (which definition has been adopted by the Barnstable Board of Health) states that a bedroom is: "A room providing privacy intended primarily for sleeping." The room designated on the Ellis Report as Bedroom 1 is NOT; primarily intended for sleeping and it does NOT provide privacy. Therefore it does not meet the 'definition of bedroom. As you can see from the attached sketch of the house in Exhibit A the only,entrance to the basement(a vented door) is located inside this room. You cannot access the basement from anywhere in the house unless you go into this room and then go down the basement stairs. No person would be able to get to the laundry area, check the heat, and go down stairs to repair anything without going through this room. Clearly this room was not intended to provide privacy or be utilized as a bedroom. Furthermore it has never has been utilized as a bedroom. 5. When I bought the property on June 6/15/1996 the seller was required to update the septic system to conform to the Title 5 requirements. The work was done prior to the transfer of ownership. Attached as Exhibit B is a copy of the Application for Disposal System Permit dated 5/7/96. The application clearly states that the house has three (3)bedrooms with a design flow of 330 gallons per day. This inspection was passed by the Board of.Health. No new regulations have been enacted since the 1996 inspection. There have been NO renovations to the property. Therefore•Page 6 of the Ellis Report is inaccurate. The records indicate that the house was .designed as a three (3)bedroom. 6. The house is assessed as a three (3)bedroom house and it has always been assessed as a three`(3)bedroom house. Please see page 2 of the attached property assessment attached hereto as Exhibit C. 7. I have put the.house on the market with Cotton Real Estate. It is marketed as a Three (3) bedroom house. See MLS listing attached as Exhibit D. The house was empty when the inspector looked inside and I can only conclude that he mistook the vented door to the basement for a closet door. Although I am aware that a room does not have to contain a closet to be designated a"bedroom", if the inspector was aware that the door was the sole entrance to the basement, it would have been clear to him that this room was not intended primarily for sleeping and that it did not provide privacy. Although Mr. McDowell is willing to do another inspection that indicates that the system is servicing a three bedroom house this would seem to be unnecessary because the septic system is in perfect condition and the Ellis Report does not state otherwise. I respectfully request that the Board of Health evaluate this inspection in light of the information contained herein and rule that the septic system at 2723 Main St. is incompliance with 310 CMR 15.00. Thank you for your consideration of this matter. Sincerely yours, Joan M. Le raw \ No. i ��l Fee $ 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Zippficatiou for Mtopogal *pgtem Conotruetton Vermtt Application is hereby made for a Permit to Construct( )or Repair(XX)an On-site Sewage Disposal System at: i Location Address or Lot No. Owner's Name,Address and Tel.No. 2723 Route 6A rimothy J. Farmer Barnstable,Mass-. 207 Capt,n Lijahts Road Centerville, ass . Installer's Name,Address,and Tel.No. 5 0 8_7 7 5—33 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5 e 3 3 3 8 J.P.Macomber Jr. J.P.Macomber Jr. k ! Box 66 Centerville,M>�ss . 02632 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(NO) Other 'Type of Building RRS No.of Persons -3 Showers(2 ) Cafeteria(NO Other Fixtures Design Flow 3 3 n gallons per day. Calculated daily flow 3111 n-3 3 n gallons. Plan Date 51 7/9 h Number of sheets 2— Revision Date i Title Description of Soil T.n n m vya a n d t o f j n a s a n d Nature of Repairs or Alterations(Answer when applicable) Ad d 3_3 3 0 R e ch A a r so u: i th 2411 i n v a r t to an existing tank and cesspool. Add one distribliti n box_ avid,` S / d� sfi6ae Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code n to place the system in operation until a Certifi- cate of Compliance has been issuedky this Bo of ` Signed Date 5/7/9 6. 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NEE■ smE■��■nONJ N.mmN������u����En�MuMmmUMMM�IN■ E■■■� �■iiOE■�I■■■■■■EEN.iENO/■SEE C■�■ NEE■n EE■o n ■..IEEE noE.■■E....sssi NEON ■ i.Mss ■ 'SEEM E■NN■oENO.Eimom ■EEEis.E=E■E.EEE�N=■s■OE.N==.■o■■N�EN E�■E■�■ENNI o■MSmmM ss ■ ■ ..■E■n■s ■ so■o■■o■.Es■M■MEN■■■ ■MEn■s■ nos.■■ ■ MMM.■M.■ E.om ■ MEN ■■■ mom ��0 lim ■�On ■ NNi EE.sn■■O■E.s■■■o■■■ ■EEEMEnN.EEi�■Hi.E■■.....■■EE..mil■■■i■=■■Em■iE■�■■�� � .iis■■ �■�■�� ■ IN IN ■ RESUME MM1 i■■ss.■E�ii■NEENNi ■EN ■■E■i■■E■E�in■■■n■ ■o■NN�■■■s■■.E■.■EEN� = ■■ ■ ■so■■NEE■N■■M■■MMMMUM�moommonMEMNON 'm�MMEENEENNI iE.MM■MMMMrMMM. ■■MMMEIENNH■■ EINN ■o ■ '11■.■M I EN■MEN■M■oEEN ■i■ons■■E■E ■■■Noi■■n■i■ ■ssHO■sisii N NE H ■ ■ MEN aml ��.��w0 Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:2723 Route 6A,Barnstable,MA 02630 Owner:Joan Lagraw Date of Inspection:June 18,2004 SITE EXAM Slope Surface water Al., 4"7 /i2v" X.,p Check cellar Shallow wells N�i4 Estimated depth to ground water 117 1 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ecked with local Board of Health-explain: ecked with local excavators,installers-(attach documentation) Accessed USGS database-explain: A44j /q s You must describe how you established the high ground water elevation: 1-17Ae- JIM �.� p. tip • f TOWN OF BA.RNSTABLE SEWAGE # VILLAGE&/ZY1 & /E.- ASSESSOR'S MAP& LOT DP STALLER.S NAME&PHONE NO. :ZP tyw-aryn be,-^ 3or. -z;n SEPTIC TANK CAPACITY 1.000 LEACHING FACILrrY: (type) 3 -e 12�er5 _(size) 330 NO.OF BEDROOMS B OR OWNER PERMIT DATE: ''�Zo-'�'COMPLIANCE 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 le Ching facility) Feet Furnished by � a n II-j �M i J �� 0q No. � �p Fee $ 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mi5pogal *pgtem Conztructiou Permit Application is hereby made for a Permit to Construct( )or Repair(XX)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 2723 Route 6A Fimothy J. Farmer Barnstable,Mass. 207 Cap'n Lijah' s Road Centerville, ass . Installer's Name,Address,and Tel.No. 5 0 8-7 7 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 Jr. J.P.Macomber Jr. Box 66 Centerville,Mss . 02632 Type of Building: Dwelling - No.of Bedrooms 3 Garbage Grinder(NO) Other Type of Building RFC No.of Persons 3 Showers(2 ) Cafeteria(NO Other Fixtures Design Flow 330 gallons per day. Calculated daily flow �1 10_3'3 0 gallons. Plan Date 5/7/9 6 Number of sheets 2 Revision Date Title Description of Soil T,n a�G a n 8 t•n fin P. g s n r3 Nature of Repairs or Alterations(Answer when applicable) Acid 3—3 3 n R es harae r s"'with 2411 i n v e r t. to an existing tank and cesspool Add onerlistribiition box. �vit� 3 � d� sfi6Ne Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and n to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo of ' al Signed Date 5/7/9 b 21 Application Approved by Application Disapproved or the following reasons Permit No. �'� Date Issued ——————————————————————————————————————— "t ~Y Fee 140. .. � No. � j00 THE COMMONWEALTH OF MASSACHUSETTS PU13LIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Ytcatiou for Migaal *pgtem Con.5truction Permit Application is hereby made for a Permit to Construct( )or Repair(XX)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 2723 Route 6A rimothy J. Farmer 'I Barnstable,Mass . 207 Captn Lijah' s Road Centerville,14ass . Installer's Name,Address,and Tel.No. 5 0 8-77 5 a 3 3 3 8 Designer's Name,Address and Tel.No. 5 0$.—7 7 5-3 3 3 B J.P.Macomber Jr. J.P.Macomber Jr.Box 66 `• r i 1 _Mq.,c4s. 02632 1Box 66 Centervillq,MNss. 02632 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(NO) Other Type of Building R.FS No. of Persons 3 Showers(2 ) Cafeteria(N0 Other Fixtures Design Flow .3 n gallons per day. Calculated daily flow 3/11 0=3 3 Q gallons. Plan Date,5/7/96 Number of sheets 2 Revision Date Title Description of Soil T.nsamov gAnd to fine sand - Nature of Repairs or Alterations(Answer when applicable) A 8 d 3-33n R e e h n A r g unai t h 24.tt i n v a r t, t� an axi ati nv tnntr Pnd r+R4gnnn1 AAr7 nna di ntri hiiti nb box� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code.a n f to place the system in operation until a Certifi- cate of Compliance has been issued y this Boat of IYal Date 5/7/9 Signed Application Approved by Application Disapproved or the following reasons _ Permit No. m 'r Date Issued -014 r' --- -- —�----y�-------� ��e.------ - _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTHDIVISION - BARNSTABLEs MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced kXton byJ,P914sa for m 3 m�t1 as 2723 Route A Barnstable.Mass.. _ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ow jel Use of this system is conditioned on compliance with the provisions e orth below: �. - f -----_=_ -- ----_- --=-= -----_- - No. °" Ag? Fee$ 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS lwi,gpooal *p!gtem Cott!5tructiou Permit Permission is hereby granted to J.P.Macomber Jr. to construct( )repair(X )an On-site Sewage System located at 2723 Route 6A arnstable,MA.sR_ 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. All construction must be completed within two e s of the date below. P Y Date: > �" Approved b - / ? i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS1 • I, Joseph p Macomber j hereby certify that the application for disposal works construction permit signed by me dated 5/7/96 , concerning the property located at 2723 Route 6A Ba n Eit a films j Mass . meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 4 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change.in use proposed • There are no variances requested or needed. SIG NED NED DATE: 517/96 LICENS SEPTIC SYSTEM INSTALLER�INTHE T01h'N OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. Existing 61x81 Install 3-330 Cesspool. rechargers� 24"-,Inv Packed in stone New D-Box- Existing 1000 0 gallon tank. 3j�> i;-�-fev DATE: 4/19/96 PROPERTY ADDRESS: 2723 Route ' 6A ,� kA '& Barnstable,Mass. f• 'i. 02630 Z 9 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. ASSESSORS N0 2. 1- . 1000 gallon pool. � PARCELNO: Based on my InR;�ction, I certify the following conditions: 1 . This is a title five.. septic system. ( 78 Code ) •2. The system is in failure. 3. The system is presently filled to capacity. 4. Must be ugraded to a title five septic system. ( 95 Code ) SIGNATURE: G 'I Flame: J. P.Macomber Company:_J. P.Macorober & Son-_Inc .. Address:--B-e-c-,66------�- - __Cente_rvilLe LMass__02632 Phone:---50-&-Z7-5=-3338------- THIS CERTIFICATION DOES NOT CONSTITUTE U A GUARANTY OR WARRANTY ffi (JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachf ields Pumped & Installed Town Sewer Connections ' P.O. Box 56 Centerville, MA 02632-0066 775-3338 775_6412 Commonweaith of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection WUllain F.Weld Trudy Coxe 000mor 8w-tNy Argoo Paul Cellucci David B.Struhs tL Governor . COrMI1WIN"r • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address; 2723 Route 6A Barnstable,Mass. Address of owner. 207 Cap'n Li j ah' s Road Date of Inspection 4/19/96 (If different) Centerville,Mass . 02632 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 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: � G✓W 1 Date: The system Inspectors 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. The original should be sent to the system owner,And copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: i Check A,B, C,or D: A) SYSTEM PASSES: �I b I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: �6 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If'bot determined",explain why not). Q� The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exilltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved �. by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)SWID49 a Telephone(617)292-SM i�Printed on Recycled Paper i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropertyAddreW23 Route 6A Barnstable,Mass . 02630 Owner. Timothy J. Farmer Date of Inspection: 4/19/96 I Bj SYSTEM CONDITIONALLY PASSES (continued) • /1/Q&1,0 Sewage backup or breakout or huh static water level observed in the distribution boot is due to broken or obstructed pipe($) 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: 4/0 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: Cesspool or privy is within 50 feet of a surface water Q[�f 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 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 system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. d,0/ The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. The system has a septic tank aad soil absorption system and 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. S) OTHER (revised 11/03/95) 2 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A I CERTIFICATION(oontinuod) i ProportyAddroaa: 2723 Route 6A Barnstable,Mass. 02630 Towner. Timothy J. Farmer "Date of Inspootlon:4/1 9/96 i D) SYSTEM FAILS: I haw datesmiaod that the system violAtss one"or=ors of the following follure criteria as deitnsd in 310 CUR 15.303. Tha bails*for this determlaation is idantlfA below. The Board of Health should be contacted to determine what will be aocauary to correct the f Backup of sewage into facility or systeia con*0110nt due to as overloaded or clogged SAS or coupool. f I �! Discharge or ponding of effluent to the eurface of the ground or surface waters due to an overloaded or eloggod SAS or cesspool 4&W, Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. „/ Liquid depth in cesspool it less than'V below invert or available volume is lass than 1/2 day Dow. A0 R44uIrod p=pb'Y more tl=4 times in the last year NOT due to eloggod or obstructed plpo(s). Humber of times pumpod _ ,db Any portion of the Soil Absorption Sy$Lein,cesspool or privy is below the high groundwater elevation. Any portion of a co—pool or privy is within 100 foot 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 60 feet of a private water supply well. Any portion of a cesspool or privy is lass than 100 feet but greater than 60 foot from a private water supply well with no acceptable water quality analysis. If-the well has boon analysed to be acceptable,attach copy of Will water&UVSL for coliform bacteria,volatile organic compounds, ammonia nitrogen said nitrate nitrogaa. E)LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: /VQ The system servos a facility with a dwign flow of 10,000 gpd or greater(La.rbw System)and the system is a SigalIIcant threat to public health and safety and tha-snvirvament boause one or more of the following conditions exists .g the system is within 400 feet of a Horace driaking water supply the system is within 200 IA+ of a tributary to'a surface drialang water supply l the system is locatod in a nitmgea sensitive area (Interim Wellhead Protection Area(IWPA)or a mappod Zone Il of a public water supply wall) The owner of operator of such rystem she!'bring the system and facllity into Ail!compllaaa with the pvundwater traltrunt prop m requL-enien4 of 314 CMR 5.00 and 6.00. Plow a consult;the local regional office of the Department for!lather information, (revised 11/Q3/95) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Add:;-8a: 2723 Route 6A .Barnstable,Mass. 02630 Owner. Timothy J. Farmer . Date of Inspcot?on: 4/19/96 Check if the following have been done: 2p�,!Pi_ng information was requested of the owner,occupant,and Board of Health. ^r the system components have been pumped for at least two weeks and the system has been receiving normal flow rates that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. plans have been obtained and examined. Note if they are not available with N/A •�_/Th rmcility or dwelling was inspected for signs of sewage back-up. +em does not receive non-sanitary or industrial waste flow '.; was inspected for signs of breakout. m components,few.hiding the Soil Absorption System,have been located on the site. r.•'.:c tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or !: xrial of construction,dimensions,depth of liquid,depth of sludge,depth of scum. and location of the Soil Absorption System on the site has been determined based on existing information or by non-intrusive methods. owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub. Disposal System. (revised 11/ 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION . I PopertyAddresw 2723 Route iA Barnstable,Mass. 02630 Owner. Timothy J. Farmer Date of Inspection: 4/19/96 f FLAW CONDITIONS !` RESIDENTIAL: Design flow:—vs Per dAr Number of bedrooms: i Number of current residents Garbage grinder(yes or no): — Laundry connected to system(yes or no):l� Seasonal use(yes or no):A Water mete:readings,if available = OZ� X i Last date of occupancy:N1k*0 COMMERCIALJINDUSTRIAI- Type of estab nt• Design flow:MYA gallons/day Grease trap present: (yes or no)a Industrial Waste Holding Tank present: (yes or no)I Non-sanitary waste discharged to the Title 5 system: (yea or no)" Water meter readings,if available: Last date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING ORDS source of info tion- sysiem pumped of ina�erection:(yes or no) If yea,volume pumped: gallons Reason for pumping l�J Fi ° ( Jd .Crst�o TYPE OF SYSTEM ; septic tank/distr1uUen4wit/soil absorption system single spool -- A)A Overflow cesspool ---d1 A Privy, , Al Shared system(yes or no) (if yes, attach previous inspection records,if any) Other(explain) AP-1- _ MATE ASiE�all components,date installed(if known)and source of information: le LS4-0 Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 JO$EPTi P-XWOMBE$&BON,INa. P.O.BOX ; aamivajA MA 0263Zoo6e 4 1 i 1 Name: Timothy Farmer Customer Code: Address: 2723 Route 6A awil5 Town: Barnstable State:Ma Zip:02630 Mailing address: 207 Capt Lijahs Road Centerville MA 02632 Notes: 75 thru 83 Bettina Dinsmore 83 system T 800.00 719191 pump T 195.00 7123191 6121193 pump T 6122 pump 1 pool°245.00 7116193 8130193 pump 1 pool&FB 145.00 9110193 812194 sew insp 85.00 8116194 516196 sew insp 250.00 pump T&1 pool 260.00 i , y i . t i W } 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress: 2723 Route 6A Barnstable,Mass. 02630 Owner. Timothy J. Farmer Date of Inspection: 4/19/9 6 SEPTIC TANK:L•y 9'#'Z&gV 7 le . (locate on site plan) Depth below grade: Material of construction:,concrete_metal_FRP_other(ezplain) Dimensions: 674 Tl Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_, Scum thiclmess: n _ 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 pum fng,condition of inlet and outlet tops or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.)--VUMP tank every 2-3 Years:Inlet & outlet tees are in nl ace No signs of leakage out of the tank: The aa=ti n tank i Q a+.riir+.iiral l&sniind GREASE TRAP: (locate on site plan) Depth below grade:& Material of construction:4L&concrete_metal_FRP_other(ezplain) A)A Dimensions: ntfA Scum thickness: Y 1 r Distance fm=top of scum to top of outlet tee,or baffle: NA Distance from bottom of scum to bottom of outlet tee or baffle: >N 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.) A .4Palje (revised 11/03/95) 6 ..r9 Uif3UYil•tiiiG rlCi if tft74J uaua vu.-•-v...•u.................... ..._._._ PART C SYSTEM INFORMATION(continued) PropertyAddres.: 2723 Route 6A Barnstable,Mass. 02630 (� Owner. Timothy J. Farmer Date of Inspection: 4/19/96 TIGHT OR HOLDING TANK (locate on site plan) • Depth below grade:.LLIlL Material of construction:/46oncsete_metal_FRP_other(e:plaia) AM Dimensions: AM Capacity 119& gallons Design flow:_ALJQ_Zal1cas/aay Alarm level: Comments: (conditio of inlet tee,condition of alarm and float switches,etc.) 1tl6 .��1B.f�l`4 DISTRIBUTION BOX:&44AN (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if,level and distn'butioa is 4qual,evidence of soli over,evidence f leakage in or out of ,etc.) T r PUMP CHAMBERl1CQ440, (locate on site plan) Pumps in working order:(yes or no)_4V Comments: (note oon*ion of pump chamber,condition of pumps and appurtenances,etc.) 11/LLo'M,'04 !7 5 (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add.. 2723 Route 6A Barnstable,Mass. 02630 Owner: Timothy J. Farmer Date of Inspection:4/19/9 6 SOIL ABSORPTION SYSTEM (locate on situ plan, if possible;excavation not required, but may be approximated by non-intrusive methods) • If not determined to be present, explain: Type: leaching pits, number:$ leaching chambers,number: leaching galleries,number: leaching trenches, number,length: leaching fields,number, dimensions: (7 overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) A15 /1."1,.*9.Vy'S CESSPOOLS: (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: to 1 Materials of construction: Indication of groundwater: 9 inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of pending, coaditi n of vegets ' etcJ Loalm sand to fine sand•Grondl,wet but no pon'ding; �1 vegetation normal. Cesspool is in failure. Mus a upgraded o a title rive septic system. PRIVY:hW, " (locate on site plan) Materials of construction: 1 Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propertyiaddresa: 2723 Route 6A Barnstable,Mass . 02630 Owner. Timothy J. Farmer Date of Inspeotion: 4/19/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks beats all wells within 100' Barnstable Water Company 362-6498 DEPTH TO GROUNDWATER Depth to groundwater. t + feet method of determination orapprotimation: Pumped cesspool at time of inspection. No signs of water table intrusion. Installed septic tank. Now water was �x>rcotiintere.d at that`tim.i?.o.� (revised 11/03/95) 9 L f THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has .satisfied the-Department's. ualifications- as -re uired ,and i -hereb p q q y : ::, r .z . - authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 2 1 A of the General Laws. Issued b Department of Eivv,lL orziic:, LUX 1 1 v e y The D�p artn ' June 8, 1995 Acting Director of the ' ion of Water Pollution Control a•rmnr+ri—IslTs'•-•rrTrnram+nssnty'1*rtre+T.rman:•sretTSTrian-•er+em muss raa-mrrerrrts a�rrrr�.trrtrr'r.�.-.i+••� � TOWN OF Barnstable BOARD OF HEALTH ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION 4 v �«•4t•I«T':•::T�T./IR«.�TT{.RT.41•If.'fRI TR1i'SIiTTf7fT'RT'{:TS•TT�iRTQI'R'IarTT•'IRR'CRPfi�RtRC•77TCT! �A •TI!•T'1T•«I/•�I•� I' -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 2723 Route 6A Barnstable',Mass . 02630 , ASSESSORS MAP, BLOCK .AND PARCEL # ��''=r�`T OWNER' s NAME Timothy JS Farmer PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P. Macomber Jr.. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE t )508 775 3- 33 FAX ( ) - 8 508 790 1578 sna,rT m.aTatr,::nenr+Ivsr�szem a as/eaaes asrla 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 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. XXXX= System FAILED* The inspection yrhich,, I have conducted 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 Dater5/6/96 -7L4 ! one copy of this certification must be provided to the OWNER, the BUYER ( where applicable) and the BOARD OF HEALTH. * If the ina ection FAILEb, the owner or•1"o« erator shall u p P pgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMRii5 . 3051 r PAR Real Estate System - General. Property Inquiry Help Parcel Id: 258 039- - Account No: 16667 Parent : Location: 2723 MAIN ST Neighborhood: 76AA Fire Dist : BA Devel Lot : 1 Lot Size : . 56 Acres Current Own: ZELMAN, RICHARD B & State Class : 101 LEGRAW, JOAN M No. Bldgs : 1 Area: 2089 2723 MAIN ST Year Added: BARNSTABLE MA 2610 Deed Date : 060196 Reference : 10236274 January 1st : ZELMAN, RICHARD B & Deed MMDD: 0696 Deed Ref : 10236274 Comments : Values : Land: 46700 Buildings : 97800 Extra Features : Road System: 2723 Index: 949 (MAIN STREET/RTE 6A (BARN) ) Frntg: 109 Index: ( ) Frntg: Control Info: Last Auto Upd: 020997 Status : C Last TACS Update : 080196 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date: 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel Press XMT for more data Next screen PAR Action Owners Name Road Index Road Name Parcel Number 258 040 RCV F (CV) 1p 5 c TOWN OF BARNSTABLE LOCATION o7 70�3 t SEWAGE # LAGE� 1ZY1 °L ASSESSOR'S MAP & LOT -��'"C VIL NAME&PHONE NO. INSTALLER'S �1 1 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) —� �e:C�nn�?Ger S (size) 3 3U t NO.OF BEDROOMS g OR OWNER "-Irl r yam' PERMrrDATE: L '"TICS COMPLIANCE DATE: Separation Distance Between the: Feet LeachinFacility Maximum Adjusted Groundwater Table and Bottom of g � Private Water Supply Well and Leaching Facility (If any wells exist Feet . on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of l hing fa����' Furnished by h 11 3 77 1 SEW GE PERMIT p0'• VILLAGE - m INSTALLER'S NAFAE & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIAPlCE ISSUED � ��� �16Y it 1 _ '