The URL can be used to link to this page

Home My WebLink About0504 BAY LANE - Health 504 Bay Lane A= 187-067 Centerville S M E A D No.2-153LOR UPC 12534 amead.com • Made In USA MUSIDNuummmt" SFIANmrf*Sato=wauffmm OFn*SFIPWWM CERTIFlED SOURCING WWWSWROGRMAAORG Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9, required for every '2014 page. City town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be faltered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Kevin J. Sullivan use the return key. Name of Inspector Ready Rooter, Inc. VQ Company Name P.O. Box 371 Company Address Sandwich MA 02563 Cityrrown State Zip Oode 508-888-6055 SI 13517 j Telephone Number License Number f i B. Certification I certify that I have personally inspected the sewage disposal system at this address a 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 mainte liance 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority October 9, 2014 Inspectors Signature Date j The system inspector shall submit a copy of this inspection report to the Approving l uthority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shred 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. t ***"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 inithe future under the same or different conditions of use. commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is required for every Centerville MA 02632 October 9, 2014 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found 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: ❑ One or more system components as described in the"Conditional Pass" ection need to be replaced or repaired. The system, upon completion of the replacemen r repair, as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y, N, ND)for the f owing statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic t k(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tan ailure is imminent. System will pass inspection if the existing tank is replaced with a complyin eptic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is stru urally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than years old is available. ❑ Y ❑ N ❑ ND(Explai elow): a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is required for every Centerville MA 02632 October 9, 2014 page. City/Town State . Zip Code Date of Inspection. B. Certification (cont.) B) System Conditionally Passes (cunt.): ❑ Observation of sewage backup or breakout or high static water level in the distrib ion box due to broken or obstructed pipe(s)or due.to a broken,settled or uneven distributio ox. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND xplain below): ❑> obstruction is removed ❑ Y ❑ N ❑ (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ND(Explain below): ❑ The system required pumping more than 4 ti s a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval f the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluatio Is Required by the Board of Health: ❑ Conditions exist hich require further evaluation by the Board of Health in order to determine if the system is f ing to protect public health, safety or the environment. 1. System II pass unless Board of Health determines in accordance with 310 CMR 15.30)3(1)( that the system is not functioning in a manner which will protect public health, safety a the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh f Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville required for every MA 02632. October 9, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, i ny) determines that the system is functioning in a manner that protects the blic health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS nd the SAS is within 100 feet of a surface water supply or tributary to a surface water sup ❑ The system has a septic tank and SAS and the SAS is wit ' a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS i within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is le s than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This.system passes if the well water analysis, p rformed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the pres ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other f lure.criteria are triggered.A copy of the analysis must be attached to.this form. 3: Other: D) System Failure Criteria Applicable to All Systems: You must indicate"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 YZ day flow f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 504 Bay Lane Property Address Robert Williams Owner Owners Name information is required for every Centerville MA 02632 October 9, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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 Systems: To be considered a large system the system must sere a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each o e following, in addition to the questions in Section D. Yes No El ❑ the system is within 400 feet a surface drinking water supply ❑ ❑ the system is within 20 eet of a tributary to a surface drinking water supply El ❑ the system is loc d in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) a mapped Zone II of a public water supply well If you have answered"yes"to y question in Section E the system is considered a significant threat, or answered"yes" in Sectio above the large system has failed. The owner or operator of any large system considered a sign' cant threat under Section E or failed under Section D shall upgrade the system in accordance th 310 CMR 15.304. The system owner should contact the appropriate regional office of th epartment. Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owners Name information is required for-every Centerville MA 02632 October 9, 2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No 0 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? 0 ❑ 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 ® El ` available note as N/A) 0 ❑ 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: ® ❑ 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(5)] D, System Information Residential Flow Conditions: 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. Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owners Name information is required for every Centerville MA 02632 October 9, 2014 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Water meter readings for 2012 184 gallons per day 2013 179 gallons per day Sump pump? ❑ Yes ® No Last date of occupancy: October 8, 2014 Date Commercial/Industrial Flow Conditions:. Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., et Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pre nt? ❑ Yes ❑ No Non-sanitary waste discha ed to the Title 5 system? ❑ Yes ❑ No Water meter readings If available: I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information(cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No pumping records found for last 5 years. Was system pumped as part of the inspection? ❑ Yes ® 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) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. El Other(describe): i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Permit and COC on file at Board of Health for system February 14, 1984. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.5' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate.of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5'x 4.5'x 4.5' 1000 Gallons 3„ Sludge depth: Commonwealth of Massachusetts .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y ry 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is required for every Centerville MA 02632 October 9, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 4-1 Distance from top of scum to top of outlet tee or baffle 611 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape measure and dip tube. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PVC Inlet and outlet baffle in good condition. Risers on inlet and outlet to within 6"of grade. Grease Trap(locate on site plan): Depth below grade: /EEJ Material of construction: ❑ concrete ❑ metal ❑Fiberge ❑other(explain): Dimensions: Scum thickness. Distance from top of scum to top o outlet tee or baffle Distance from bottom of scu to bottom of out tee or baffle Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is required for every Centerville MA 02632 October 9 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels asrelated to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time/inspeopn) ate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglasylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: El Yes El No Date of last pumping: Date Comments(condition of ai/laand oat switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9 2014 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): Distribution box replaced with new H-20 D-box and H-20 Riser to within 6"of grade. Certificate of Compliance on file at Board of Health October 8, 2014. Pump Chamber(locate on site plan): Pumps in working order: /and ❑ No Alarms in working order: ❑ No Comments(note condition of pump chamber, conditioces, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS. not located, explain why: i Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner I Owner's Name information is required for every Centerville MA 02632 October 9, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (1)6'x6.5 w/ 1'ofstone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ 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.): Uncovered and inspected leach pit. Leach pit appears to be H-10. Client to install barrier in driveway to prevent vehichle traffic on leach pit.Water level 4'8" below invert. Root intrusion present in leach pit. Leach pit is 2' deep with no riser. Cesspools (cesspool must be pumped as part of inspection) (locate 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 constructio Indication of gro dwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9 2014 required for every , page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, co dition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of/gnsaulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form-.. Subsurface Sewage Disposal System Form Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is Centerville MA 02632 October 9, 2014 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ------------ AI=�8w Q3- yS a 1 AV..: yo ' r yt,On � 3 iy 37'. 0 r � I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane Property Address Robert Williams Owner Owner's Name information is required for every Centerville MA 02632 October 9, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: <12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: October 12, 1983 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database_-explain: www.terraserver.com ma.water.usgs.gov You must describe how you established the high ground water elevation: Test hole record on file at the Board of Health October 12, 1983 no water found at 12' base of leach pit is 8'deep. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts .UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 504 Bay Lane . Property Address Robert Williams Owner Owners Name information is Centerville MA 02632 October 9 2014 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria.Applicable to All Systems) completed Z System Information Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file F No. P-o I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppricatiou for Misposal opstem Construction VPrmit Application for a Permit to Construct( ) Repair(V�Upgrade( ) Abandon( ) ❑Complete System Z Individual Components Location Address or Lot No. 6bq Sj LA, &1v-d e_ Owner's Name,Address,an T .No. n Assessor's Map/Parcel 4 B 6 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 8_J� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank lW LIA, Type of S.A.S. 4&L Rk Description of Soil or 4 Nature of Repairs or Alterations(Answer when applicable) 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 not to place the system in operation until a Certificate of Compliance has been issued by this Board of e nth. Signe / Date ® / Application Approved by Date �( Application Disapproved by Date for the following reasons Permit No. O I H — Date Issued d f o (,� No. �O I I � Fee _ �/ THE COMMONWEALTH OF MASSACHUSETTS Entered ineomputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppIfiation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(Vl�Upgrade( ) Abandon( ) ❑Complete System M Individual Components Location Address or Lot No. So'l 5,c l LA, C94 terr,Ile- Owner's Name,Address,and T .No. / r` Assessor's Map/Parcel g _ 6 C Installer's Name,Address,and Tel.No. Se�s��P�,��ad`c�� Designer's Name,Address,and Tel.No. ,r-� ler � 17.7an Type of Building: 7 Dwelling No.of Bedrooms '�f y Lot Size sq.ft. Garbage Grinder(d) n Other Type of Building m p No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,r Design.Flow k(min.required) A-- gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank &W 6a Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) p -&O f Date last inspected: Agreement: y The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in " accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe / a Date 101711 Application Approved by Date Application Disapproved by Date for the following reasons /R Permit No. p2 O Date Issued --------------------------------------------------------------------------------------------------------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIF that the On-site Sewage Dispo�saalsystem-Constructed( ) Repaired(Upgraded( ) Abandoned( )by at 50 Lf r / has been constructed m ac ordance with the provisions of Title 5 and A for Disposal System Construction Permit No.aG I L dated �0` r L Installer 1 Designer #bedrooms �(1&w Approved design flow N ; gpd The issuance of this permit shall/nowt be eo ssttrrued as a guarantee that the system wtl�nction a,designed l. j� � Q�� Date �/ ( ! / �j !��/ Inspectors `/ / i (R . .77t` f ----------------------------------------------------------------------------------------------------------------------- --------------- No. GI Q al f Fee !V(/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal &pstem Construction Permit Permission is hereby granted to Construct( ) Repair ) Upgrade( ) Abandon( ) System located at SS 6 L( and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit./ C � Date Approved by o , ,�✓✓�.ti FRs....11v:.. .......... V THE COMMONWEALTH OF MASSACHUSETTS SO BOAR® OF HEALTH .e✓ ...................0F... .. Appltration for Dhipaaal Workii Towitrurtion rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ ..... ..._..........------------------------------------------------- location-Address or Lot No. . 7, ...... �® / caner tddress a Installer Address UType of Building Size Lot ..-?/_ ti....Sq. feet Dwelling—No. of Bedrooms........ ______________________________Expansion Attic A.r Garbage Grinder o�e)P1t aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow___ _.....XJ�.....gallons per person per day. Total daily flow__Z?_'-_t0............................ WSeptic Tank—Liquid capacity..OAW gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length........... Total leaching area....................sq. ft. �' '� ___ Total leaching area__�_0 s ft. � Seepage Pit No.______�...___.... Diameter__________ _______ Depth below mlet___�___________ g ______ q. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b -_ _ _X�f.... _-�!(�_t_:_.__!A XCe_P Date__7_-�__a � a- y -------------- Test 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__-____________________- --------------------------------•--._...-----------•--•---••----------------._.......--•----•--.._..........---------------••-------------------....---...._: 0 Description of Soil_.,e?1G,0./.& --------f --•-------------------------------------------------------------------------------------------------------•-•----- x U ---.._•--•------------------••-------------•------••••----------------------..................................................• W UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 boa d of health. gned- v -------------• l �•------ Application Approved B _______ _____ _ Application Disapproved r e following redsons_________________________________________________________ _ -••---•-----------------------------•----•------...--------------•---•-•--------------.......----------....•-•••-••••••-..___. PermitNo......................................................... Fimic THE COMMONWEALTH OF MASSACHUSETTS ,,��••�- BOARD OF HEALTH ........t v..!t!..._................OF...43 � ....................................... Appliratiou for UWpaiial 10orkii Toutitrnrfiun Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• �' G c% Location-Address , or Lot No. /� 'l..f?...._G?.:r.+s�......7.......... /1� 1��='• -- 7.....1� �.:� !4'.''a-l.'!�........ • ---- ' wner Address / �.��7 . �.e!e! .�!r4/�. ?..!.:. zk/....er ....----•-•. Installer Address QType of Building Size Lot.��._6.-20..-�4 •..Sq. feet U g—. .....Expansion Attic �/ji�M,� Garbage Grinder �ti a)t/F Dwelling �10. of Bedrooms.___.___.._�_________________________ pal Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q1 Other fixtures .... ••----•-..-._ Design Flow.... �`3......................gallons per person per day. Total daily flow.., �Q..._........_..___._....._._gallons. W - WSeptic Tank—Liquid capacity4.d° gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.........../...... Total leaching area....................sq. ft. Seepage Pit No........f-________. Diameter.....lS...__...... Depth below inlet_._.............. Total leaching area.. _+ j9._.__sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed by- 4.X ... _.!�!�� '..." Jtit__ Date..S_' .._"` Z--..._.... Test Pit No. 1.....Z.-.....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 ..._...._r f./110 x U •----------•-----•.....................................•-----•-----------------•---------------...----...------------•------------------------••------•--............................................ W -------------------------------------------------------- -••---------------------------•-•---------•--------•-------------------•••-•••--••••-------••------••-•----••--•--•--••-••-••-•-••-•........... VNature of Repairs or Alterations—Answer when applicable............................................................................................... •---------------•---•---•------••----------------------------------•---••-••-•••----••-•-•--•••-•••••••••----•-----•••--•--••-•---------••••••--••-•----••••---•------•-••••................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE; 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 boa d of health. P,h_ 1_71 ate Application Approved BY - --------------------f ;. ..' Date Application Disapproved for die following reasons:--••--•••••-••-••••••••••--•-•-•-•--•---••-•-••••--•--••••-••-••-••-••-••-•-•••••-•--•••••-•-•••••............... ....................•--------•----•-•-------•--......---------------------•••--••••---••--•••--•-•--•••----•••••••-•••-•--•-----••-•----•-••••-•••--••--•-•...---••-••••--•-••••-----------•-••••------- Date PermitNo.......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................OF..................................................................................... ,. �rr�i�irtt�r oaf f�unt�li�nrr • TH ,. -TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) F. -. by =--- . = f Installer ` 1a .. 7 l has been installed in ac dance with the provisions of TITLE 5 of The State Sanitary Coe described in the application for Dispol Works Construction Permit No..... ..... dated_'` !y/ .......................... THE ISSU NC OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® GUARANTEE THAT THE SYSTEM 1All F TION SATISFACTORY. DATE__ - Inspector........ _............................•-•••-•••--...... ••-•••••-•••••••••••-•••--•-••••••-•--••••---•._......•--.----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 ...........................................OF..................................................................................... y N ........... ........... FEE........................ DW110o 1 IV Tomitnulivit amit Permission is her y granted.__._< --- --..'............ to Construct ( or ir!��__j an,,Individual SP.N6,a Disposal System at No........ ...... � j • ------- ` '' ='I ..... Street as sho on the aPPlicatio -for Disposal Workso ruction"Cc Permit �o-% ....... Dated.......................................... /,. . ............... •-•--•••------•-••-----------•-------•-••-......-••.................. Board of Health DATE............ ..... ........ ............................................. FORM 1255 HOBBS & WA REN, INC.. PUBLISHERS ICI L 0 AT ION ff SEWAGE PERMIT NO. 1� 5� y 4a� C VILLAGE INSTALLER'S NAME i ADDRESS BUILDER OR _ OWNER DATE PERMIT ISSUED lk pDAT E COMPLIANCE ISSUED �� . � Sao �� ,� M,� �-9 � � ® � �� C+ �J i ,� pESIGti1 C) =— .I �aING� FAMILY - � BCOR�OM �� yk 1, pAll.�( r%-bW _'IIvx 3 = ?,30G.P �• [ { II jEPT1G TP�K = 33ox15o% = 4976.Po �, : te• II u5� , o0o GAL. }. ' 1 D L�L• PIT U 5 E t v o 0 G 4 t_. �i'�-� �LA� � p1 , � l� � LAO& t, II 5 'ToTA1-. DESIGN • ,421 J GPD. lr1�Nl �-I�•Y M& /� (� -TOTAL. DA I I^Y I, PE2C0LATI0W RATE : I"IN ZMIN o�L�55 OF M,S ALAN yGn c� RICHARD W. Ae II A. "' AF BAXTER JONES CAr„ & 2404O N 251OQ 4 A Q w TO P FND=I :• � i 1000 INS• DIST. 5v>g`adL 0�K lug. SEPTIC 21 Z, Joao INJ. 21.li -rn,NK Ga.�. 51A ' INV. INV. P 1 T '4 ZI S u/ITu ' Z.WASN6D , II II 6TvN6 M1�• CIS _� • SAS --.�r�.-- �� -�-�'��' . ' CERTIFIED p1,-oT PLAtJ • P R U F I L� L o L 4-t 1 o N �y�j�jL1,/ I C..L..� 12 Wo SCALE 5CALE •�"I•.�, I'�-�f'o'=„mob' p L.p."N RE>= E�ZE►� GE +1 w �TIF 1 CERY THAT THE A �� .-I►3G. SNowN t � '! NEt2SOW CoMpLYS yJITN Z HE S I of LIN .�-a1 s ;3 Auo 56TEGK 2sQ�i2EMENY> oF 'tN� To w►� o F ' ARt��iTi4E3*;.e3oAo o LOCATED W MAI T 6 G L DAT E In-I'L B A xT E IZ.a p.,l`(E INC. � REG 15'r 6Q6rU'I..A1�D 5 u i�v EYo2 TuIS PLati I S IJorr f3�Sf:r� o►d AN os-rE�vl�t� - MASS II I>JSTRvME►.rT ',VQVC-Y_ `rNE n1=SETS Suoul,� SIL�/ID, -� �iLI/I!�► APPLICP.►-JT