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HomeMy WebLinkAbout0042 ASHLEY DRIVE - Health 42 Ashley Drive Centerville P A = 172 090 UPC 12543 �a No..�..63LOF HASTINGS.MH 1 ■ H■■■H/■■■■■■■NNN/■■ /■■■NN■■ ■ ■ ■■■■t■i■t■■■■■■■■■■OEM/t■■N/■■■/■■Nq■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■/ ■■■q ■qmom H■nn■■■N■■■■ ■ q■■■■■■■■■n �■�tn � ■ern■/■■lion ■ ■■■■■tn ■/■■■■■■■■n■nt■■■ ■ ■�■■ ■■■ ® - • N■■■■��■n■t■i■i■■iH■/■ '■t■■i�ti■■■Sol t■t■■■■■■■■■H■■■t■ ■■ ■■■■■ti■■■■t■H■t■m■■N■■ ■■Ht■=■■■■■■ ■■ ■■N■t■s■■■q■/■■■■ ■■■/■ ■ =■■H■■■■ an a■■ ■ ■■ //■t■■■H■n son ■n ■■ N ■■■■■■■■■ N ■ ■■■ ■■ /■■H■■ ■MMO � NanRSMM � i imMSEN■ N■ q ■t■ ■■■/ ■■ 0 ■■■■■t ■ no an t■■■■■nt © �n=■■■t■�t �■ ■n■ ■■■■H H■n■■■■■ i■nt■■t■ N■■■ ■ ■■ ttt q■■■■ ■gt■gttt ■ ® ■■ ■■■■t�na n tat■ �iiq ■Mamma■ � eqt■■ q■■■gN■t■■Hi ■ttt■■ ■■�i/■qn■ N■ A`� H ■■■/■NNN■N■■■■■■N■ N ■ ■ 1■■HH ■■■N �• � gt■■■qtt■■ ■/■q�:■ �i■nt■■tt■■t■qt■ �i■■■■N■H ■■■■■/■■N/q■N■■ ) NH■N/■ ■tN q ® t ...p ■ ■oma�i■NH■ 1N■■/■■■■■qN■I■■■q■ NN■■■■ �l ■ ■■■/■■■■■■■■■ qq■■■ NH■/■ mom was ■q■Nn■t■t■■/nan 0 am MUMMEM N N n�■■ ■N■ ■■■■qqq■ , t n■■■nnt �■ iia iiifi��■■ ■0 mammas l� tHN■■■ Ham ■ ■�■M!//NH�■/: an � \ H HN■��1��■ �t�' ta�•.a ■�■■■fit■� ■q■HNN■t■■ t H ■ ■ ■■N a■■t ME an n - ■ MOM ,n/■■N■N■/N�t N ►■■�■ N■■a N nr `i■� N _ y■ \� ■ N■ Samos on qqq ■ l■ 1■t���l�f�l� aN ■ i■ ■q ■n tt■ � ni■q TOWN OF BAR,,NSnTABLE LOCATION �' SEWAGE # -lq VILLAGE C QA o EA.0 ASSESSOR'S MAP Sr LOT 17J - b 10 INSTALLER'S NAME Cz PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS-PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: ,,5- Iv . �% DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �- 0 p � rP 10, t ell o� i X;. i Fro vide-d 8f #orn e d wr e-r TOWN OF BARNSTABLE �"�oZ, o2pp� LOCATION SEWAGE# VILLAGE C e1 = ASSESSOR'S MAP&PARCEL 17 Z O "I 6 INSTALLER'S NAME&PHONE NO. - L p? SEPTIC TANK CAPACITY l O d LEACHING FACILITY:(type) + 6 X4 ize) 00 O 6`e,/ NO.OF BEDROOMS 3 .OWNER PERMIT DATE: / _ COMPLIANCE DATE: Separation.Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY 7 5�S ° L 19)y �L r )Sz 01 J . �zz r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 42 Ashley Drive Centerville, MA 02632 RECEIVED Owner's Name: Wayne Hayden Owner's Address: Same JUL Q 2 2003 Date of Inspection: June 19, 2003 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Map: 172 Mailing Address: P.D. Box 49 Parcel: 090 Osterville,MA 02655-0049 Lot: 99 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Ne ds Further Evaluation by the Local Approving Authority Fa 1 Inspector's Signature: Date: June 25, 2003 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 3,10 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ 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 '/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 SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is 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.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ _ Pumping 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,excluding the SAS,located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ 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: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied 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): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2002-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE 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 current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: The pit was added on May 31188-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 7 Page 7 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Ashley Drive Centerville, AM Owner: Wayne Hayden Date of Inspection: June 19, 2003 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete _metal fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Baffles were present The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping every two years. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _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 baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _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: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: None (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 of pumps and appurtenances,etc.): 8 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: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I - 6'x 6'- 1000 gal. (H-20) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: ✓ overflow cesspool,number: 1 Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): The overflow cesspool was S'W x S'T x 8'bottom to grade. Liquid was up to the outlet tee. The cover was 12"below grade. The leach pit had 6"of water on the bottom. The scum line was approximately Y up from the bottom. There were no signs of failure The cover was 2'below grade. The bottom to grade was 9'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(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.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 Map: 172 Parcel: 090 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot:99 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. A � B uk S 3 0 O a i A 13 1 5101 y7 a. a3 Sa y O 3 a-o -7 4 PIT 10 I Page 11 of 1 l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Ashley Drive Centerville, MA Owner: Wayne Hayden Date of Inspection: June 19, 2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40' +/- 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) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 40'+/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 \JT]OWN OFBARNSTABLE LOCATION ` ASA/e-`7 `J SEWAGE # VILLAGE CC✓tT�Grtit ICE:_ ASSESSOR'S MAP & LOT 05 0 INSTALLER'S NAME&PHONE NO. LbT 9 9 SEPTIC TANK CAPACITY oyp LEACHING FACILITY: (type) S wX F jT(size) /6" G11�. NO.OF BEDROOMS 3 BUILDER OR OWNER La4iJAA- C n PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 leachinggacility) Feet Furnished by r y P , k � a a3 fa � a 3ao �lo PIT y . D No.? Fimim $....2.0—DiD THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .......Town.... --......OF.....Barmst:dble.... .--------------------.------------.------------ Appliration for Uiipoii al Works Tomitrurtiom Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair :kX ) an Individual Sewage Disposal System at: 42 Ashley _Road__Centerville -----------------•-----............--- •••---•---------•-.....--•-•------•-••-••-----•-•---•.........--------------•----•.............•-- Location-Address or Lot No. Y�t��rxi ....................................................... ......._..••-•-----•-----........--•----•----••......----•-•-----••-•-•............-•----•-----•. Owner Address s7P.,.MS1C. jMbe]:.....................•--------....-----------...--•-•-. .................................................................................................. Installer Address QType of Building Size Lot............................Sq. feet Dwellingxx No. of Bedrooms.................. ........................Expansion Attic ( ) Garbage Grinder ( ) pP4 Other—Type of Building ............................ No. of persons.....----................--- Showers ( ) — Cafeteria ( ) G4 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit-------------------- Depth to ground water-.---------..-..-..----- (i, Test Pit No. 2................minutes per inch . Depth of Test Pit.....---......--.... Depth to ground water........................ a -•••--•-•••••-•••------•----••-------•-•-••.......••---------------------•--•---•-•-•--••--•------...........------••••---•--•••---••......_.........._.•-•-. 0 Description of Soil........................Sand...&---Dxavel.......--•-•----------------•-•--•-----•-•----------•-•--•----••----••••--•--..... ------------------------ U ..................o•-•----••••••••---------------------••-----------•----•-•••••........--•-----•--•-•-•-•-•--•-------•---•----•-------•---••-••---••----•-----•••---•----------------••......---•-•--- W ----•-••••-•-----------••------•-••••••••-•-•--••------•-•-•------•-------•••---•------••---------•-----•--•-•-•---------------•-----•----•-•-•-•--••-•--•---•-•-••---••--•--•-•-•-•-•-•••-•-•-•-•---- UNature of Repairs or Alterations—Answer when applicable.--------1,1-0-III---g.a_l.1an...Leach...P'i-t-.-_---------------- •-------------------------------•--••------------------=---------------------------------------------------•-------------------------------------------------------------•......--••--..........----•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti IT, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b theoa of healt. .Signed- . .......... ................. --5./24/8.8........... Date Application Approved B r Date Application Disapproved for the following reasons---------------------------------•--------------------------------•--•-------------------....................... •--------------------•-----.....---•---------------••-••••••--••-•-••_..---•-•--••••.._..-•-••--•--------I--------•--•-••••-•-------- -----•-•------------------ - - Date .Permit No...... -. -•----------------------- Issued _.__--•------•----••••-•-•-........................... Date THE COMMONWEALTH OF A 41 FEB........$..... S�.a. 1.0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................Town.............O F......�?.mat.a.ble....-----------...................................... Appliration for Diopooal Work,i Tonotrurtion thrutit Application is hereby made for a Permit to Construct ( ) or Repair kX) an Individual Sewage Disposal System at: 42 Ashley Road _Centervill-e ................--•------• ._....----•.....--•-----•------------- ------------------------------•-----•----•--•••-••--------•------••----•--................._--••-- Location-Address or Lot No. Owner Address a .............................. . c 24'X....................................................... .......--•----•---•------....•.......------............----........----------..............._. Installer Address Type of Building Size Lot............................Sq. feet Dwellingxx No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther 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 ( ) 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........................ R.' ------------------------------------------------------------------------------•--------------------------- -•... •-------•----•...... ........ ..... •---- ODescription of Soil------------------------S xa. __- Cravel...•--•--------------------------------.-----------...................................................... W U ---•----------•---•---------•-------------------•-•----•-•-------------•----•-------------....---------------------------------------------------------.._..._...------------------------............. W -----------------------------------------------•-•------- ------------------------------------------------------------- -----•---------•--------------------•---------------- ......................... U Nature of Repairs or Alterations—Answer when applicable________!_-10©Q_..g 1_1-011___lgacb_......................... ----------•--------•..................................••--•---•--•----------................•-------•---------------•-----------•--•----------------...--------------•------•--................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITi p of the State Sanitary Code— The undersigned further agree not to place the system in operation until a Certificate of Compliance has bee issued b )e,�I�ard of healtSigned /-'I✓ ._. r `� 5 2 a 8.. _` ._.. -- �--------------- -51 ---Z-_._.-.......... Date Application Approved By.................. S_-Z. . Date . Application Disapproved for the following reasons---------------•---------------------------•------•---------------•--------••----------------•--•---------------- •...................•----------•-•-•--------•------------------------------------------...----•--••------------•-••-----------•---------------------••-••--•••--------------------------•---------•---- Date PermitNo..... ZS_:.. _ ---------------•------•-• Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........I...Ton.................OF..........Barn.staiale.................................................... Trr#ifirtttr of &-imptionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X3 by _J.P.Nac©mbe ---- •-------•-------------------------------------------- _--. ------•--•---------------- 42 Ashley Drive Centerville Installer at.....................................................................................................................•-------•----------------•--- --------------------------------------------------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---- -------- dated--...--_-_____________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........................•-+� �.-_ -- ...................... Inspector...............�_z..-----------------......._........---...-----•-•--- THE COMMONWEALTH OF MASSACHUSETTS / /1 s S CS %�'J BOARD OF HEALTH Town Barnstable ...........................................OF............................................................. 2000 FEE.- ---.---_.`........ Rop000l Worbi Tomitrudion rrmif,,/ Permission is hereby granted.................J.P.NacOmber......................................................................................... to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No...... Ashley -Drive Centerville . . . . ..... . ....•--•-•-•.----- -------------------------•--•----•----------------•--------•---•-------................. Street as shown on the application for Disposal Works Construction Permit D)ated.......................................... ............................................ __••-•--------------•-----•----_----•-- rd of Health DATE------------------ l ................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS