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Home My WebLink About0035 BRETWOOD LANE - Health 35 BRETWOOD LANE CENTERVILLE A= 168. 120 a 1�1 q&cvctro-Qty� UPC 12534 No. 2-153LOR HASTINGS, MN ^T Commonwealth of Massachusetts 0JO)e Title 5 Official Inspection Form Subsurface Sewage Disposal System:Form -Not for Voluntary Assessments ,M 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name '` information is Aj required for every Centerville _ MA_ ,May y 7 2018 _ _ �. page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, 1303 use only the tab 1. Inspector: key to move your cursor-do not Patrick T Sullivan key.usethe return Name of Inspector Ready Rooter Excay ng_ Company Name ---- — PO Box 89 Company Address — Forestdale _ MA _ 02644 City/Town State Zip Code 508-888-6055 SI 12843 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority May 9, 2018 Inspector's Signature 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 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. ****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. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °,M •'•v 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,Q,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" section need to be replaced or repaired. The system, upon co pletion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not deter coed" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 ar s old or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltra * n or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is re aced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass nspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that t tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection.Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 35 Bretwood Lane Property Address Thomas Marcello Owner Owners Name information is required for every Centerville MA 02632 May 7, 2018 page. Cltylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or b ak out or high static water level in the distribution box due - to broken or obstructed pipe(s)or ue to a broken, settled or uneven distribution box. System will pass inspection if(with approvaf f Board of Health): ❑ broken pipe(s) are re aced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is remo ed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box i leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND .below (Explain ) ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluationrbheby the Board of Health: ❑ Conditions exist whirther evaluation by the Board of Health in order to determine if the system is failing blic health, safety or the environment. 1. System will pasard of Health determines in accordance with 310 CMR 15.303(1)(b)that th not functioning in a manner which will protect public health, safety and the envi ❑ 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 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection_ p Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Bretwood Lane Property Address Thomas Marcello _ Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is.functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil a orption system (SAS) and the SAS is within 100 feet of a surface water supply or tribut to a surface water supply. ❑ The system has a septic tank and S and the SAS is within a Zone 1 of a public water supply. ❑_The system has a septic tank an SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank an SAS and the SAS is less than 100 feet but 50 feet or more from a private water supp well". Method used to determine di ance: *" This system passes if the ell water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates sent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, prov ed that no other failure 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 Y2 day flow. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not of for Voluntary Assessments wM 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 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 serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"ye$" or"no" to each of the following, in addition to the questions in Section D. / Yes No ❑ ❑ the system is withi 400 feet of a surface drinking water supply ❑ ❑ the system is w in 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is ocated in a nitrogen sensitive area (Interim Wellhead Protection Area—IWP ) or 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 Section above the large system has failed. The owner or operator of any large system considered a signifi nt 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is Centerville MA 02632 May 7, 2018 required for every _ y page. Cityfrown 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 ® ❑ 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: ® ❑ 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 GPD t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Ti •Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 35 Bretwood Lane Property Address Thomas Marcello Owner information is Owner's Name required for every Centerville MA 02632 May 7, 2018 page. City/Town 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? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2016= 186 GPD Detail: 2017=216 GPD Irrigation on meter. Sump pump? ❑ Yes ® No Last date of occupancy: Current 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., etc.): - Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments is 35 Bretwood Lane Property Address Thomas Marcello Owner information is Owner's Name required for every Centerville MA 02632 May 7, 2018 page. Cltylrown 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: Owners records: Pumped 4 years ago 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) ❑ 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. ❑ Other(describe): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 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: System installed 04/04/1979. D-box and piping from tank to d-box and d-box to leach pit replaced 05/07/2018. Certificates of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 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: 3 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: 10.5' x 5.5' x 5' Sludge depth: 5 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurfa ce Sewag e Disposal System Form Not for Voluntary Assessments •`'� 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 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 29 Scum thickness 8"at inlet, 3"at outlet Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Dip tube and tape measure. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet concrete baffle and outlet tee in place. Liquid level at outlet invert. Risers bring covers within 6" of grade. Tank to be pumped and cleaned by Ready Rooter, Inc. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to op of outlet tee or baffle Distance from bottom of s um to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is Centerville required for every MA 02632 May 7, 2018 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 as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fi rglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition o alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. City,Town 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 11 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.): Installed prior to inspection. One inlet, one outlet. H-20 DB-3. New, no solids carryover or high water staining. Riser brings cover within 6"of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump hamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Bretwood Lane _ Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-6' x 8' w/stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions.- El 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.): Liquid level 3.5' below invert at time of inspection. High water staining 20" below invert. Clean stone visible in sidewall with mirror. No sign of past hydraulic failure. Riser brings cover within 4"of grade. Cesspools (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 constructi n — Indication of groun water inflow ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is Centerville MA 02632 May 7, 2018 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soi/sofraulic failure, level of ponding, condition of vegetation, etc.): /Z t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. City/Town 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 I i { v- = 3Q ' CIL t5ins.doc•rev.6/16 Title ace Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 35 Bretwood Lane Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. Cityfrown 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: '4 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: 03/16/1978 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: maps.massgis.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 1978 found no ground water at 14' (elv= 14). Base of leach pit 11' below grade. Accessed local ground water contours and to oP mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts rm Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Bretwood Lane____ Property Address Thomas Marcello Owner Owner's Name information is required for every Centerville MA 02632 May 7, 2018 page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist Z Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. �/ / Fee -7 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1e _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitatlon for Bisposal *pstrm Construction permit Application for a Permit to Construct( ) Repair(grade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. 5 �� Owner's Name,Address,and el.No. 3--1 12 Assessor's Map/Parcel 6 ( a 0 �`� �...�' �� 6 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Te o. 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 Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) r� `�> 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 Health. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /&— Date Issued No. Fee /� '{ 75 �[ () �/ / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye-2! PUBLIC HEALTH DIVISION -:TOWN OF BARNSTABLE, MASSACHUSETTS Application for Bisposal �6pstrm Construction Vrrmit Application for a Permit to Construct( ) Repair(v1 pgrade( ) Abandon( ) ❑Complete System ndwidual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. 3� C 3S rcCW L� Assessor's Map/Parcel C� (( 'a _:Z , Installer's Name,Address,and Tel.No. Sad `� <�c�.t> Designer's Name,Address,and Tel.,No. 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(mina required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title r Size of Septic Tank Type of S.A.S. L C-r1Lw�, Description of Soil Nature of Repairs or Alterations(Answer when applicable) S-,' 1—,t `.�""� R)2 1 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 Health. Signe Date Sl Application Approved by Date71 Application Disapproved by Date for the following reasons Permit No. CPO/& -13 , Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�X Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N6�01'a7 "/3/ dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall)not be construed as a guarantee that the system will function as designed. Date / Inspector No. O Fee 75 THE COMMONWEALTH OF MASSACHUSETTS �? PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �i8�108a1 �pstem DnstrUCtion �ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at i 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 mus.,be c•m leted within three years of the date of this permit. Date rj 7 Approved by TOWN OF BARNSTABLE LOCATION J y-�� SEWAGE# RM\7 - 17 J VILLAGEC,n 7B_4�-"S1 e-, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE No, , � �,� SEPTIC TANK CAPACITY `�,�� Q& LEACHING FACILITY: (type) Lo, (size) NO.OF BEDROOMS OWNER idorr CV"-N.,t,.r,c 0-1, PERMIT DATE:_ -2 COMPLIANCE DATE: 5 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) j Feet FURNISHED BY 'mow✓�" a 3 Q f 06-08-1998 11:12AM CENT OST FIREDEPT 5087902385 P.02 wiaR2 appnaauun w wcai rrre ueparunenL Fire Department retains original application and issues dupfi ate as Permit., 00 C -r �h�rr�irne�zG'a�C�uxe C�ix�iceQ.— �o�rr'u�o��v� ✓�xez�erya�,ran APPLICATION and PER L s`''' F; �310 00 MST Fee: for storage tank remcv-a1 and transportation to approved tank disposal yard in accordance with:the provisions of M.G.L. Chapter 148,Section 38A, 527 CMR 9.00, application is hereby made by: • =Md- l� Tank Owner Name(plea print) Thomas Marce llo .X 7 Address 35 Bretwood Lane, Centerville Surer COY Swim ZrP Company Nalne Roderick Construction Co. or Individual Pnnf P� Address 516 River -Road Address r pm (- Signature(if applying ftr_ermit) Signature(if applying`cr=ermit) M 1FCI Certdie-- Other C IFCI Certified = LSP# Other Mao Tank Location 35 Bretwood Lane, GuV �/n . � ��eetAtldress �P v Tank Capacity(gallons; _ Substance Last Storms- #2 Fuel Tank Dimension 4e =x length) d Remarks: Y0 t Cr't Firm transporting was- Barnstable Landfill State Lic.# Hazardous waste E.P.A. # Approved tank disposal raid Barnstable Landfill Tank yard# Type of inert gas Tank yard address Flint Street, Marstons Mills Centerville 01920 City or Town FDID# Permit# Date of issue June .1, 1998 June 15, 1998 at of expiration safe approval nunve> 982300703 Dig pP g afe Toitree Tel. �er0 22.4844 Signature/Title of Officer canting permit After removals)send For ?-290R signed by Local Fire Dept.to UST Regulatory Compliafm Unit, One Ashburton Place, Room 1310, Boston,MA.CZ-08-1618. FP•292(revised 9l961 TOTAL P.02 C-7 No.........//40...... .J~.�.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ..... ... . ................O F......................................................................................... Apphration -fur Uhipv al Worko Tomitrnrtion Prrntit Application is hereby made for a Permit to Construct ()() or Repair ( ) an Individual.Sew e Dispo 1 I System at: f v ,1-' - � ----------•-•-- L cation.Address or Lot ner Address ',•---------------------- rs Installer Address Type of Building Size Lot---10®0-_Sq. feet I Dwelling—No. of Bedrooms.__----------------------------------_-_-__Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building __-_--______________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ---------- ------------------------------------------- W Design Flow------ '`'®---------------------------gallons per person per day. Total daily flow............ ................gallons. WSeptic Tank—Liquid capacity_07 gallons Length._..k_0-____-i,�Width._ ..._.._-- Diameter................ Depth___.. .... x IDisposal Trench—No. .................... Width-------------------- To 1 Len gth__________._--..-_ Total leaching area-------.------------sq. ft. Seepage Pit No--------------------- Diameter______ __-.-___- Depth low in'et....49........... Total leaching area_/.��______-sq. ft. Z IOther Distribution box ( ) Dosing-tank a '.Percolation Test Results Performed by.�,�f..�1�..�:+ /t'�J¢___vL�....____.__. Date......... a Test Pit No. 1...P__ .__minutes per inch Depth of Test`P.it1.__� '.`_.___ Depth to ground water-----4-1 j5 ✓ w Test Pit No. 2...5t.. ...minutes per inch Dspoth of Test Pit---- / ------- Depth to ground water....1(?a"Zr 'z- -- ...K...f...fa,-O------`--• ------......................................................... O Description of Soil 4rlav - x w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------.--------._..._______.___..--- I.............. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- jAgreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with `the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig d .. . . ...••... � ' �� ! --- --------- -- .... /� Date 'Application Approved B t� c3_-_1_ ....... .:. PP PP Y (,l/I/� Date Application Disapproved for the following reasons:--••-------------------•-----------------------•------------•-•---------•---------•----•----•--•--------------•- -•-•--••----•--------------•--------------•-•---------------•-•-•---.....------•------•-•---••-----.........---------•--•-----------._...--•------ ..................................................... Date Permit No......................................................... Issued. - 7 Date �0 fi [ NO......... � .............._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o- t - ._._..........OF..................................... .. . ........................................... t ApplirFatiun -fur Biu oott1 urk�i Tonitrurtion-' rranit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: ........................ ocation-Address ...�- •.•....-.-or�`i.iof�No. W R�� Wn Addres � � P -------------------------- -----�.+- f' 4. Installer r Address d Type of Building Size Lot-- Sq. feet U Dwelling—No. of Bedrooms---- ''----------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building _.------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow.....& P------------_---------------gallons per person per day. Total daily flow..........3.3 __________..__....gallon. 1 W Septic Tank—Liquid capacity 7 gallons Length..A.0....... Width.S.----..--- Diameter---------------- Depth...... _.. x Disposal Trench—No. .................... Width................ Total Length.................... Total leaching area.......-------------sq. ft. Seepage.Pit No..................... Diameter------rrA__......... Depth below inlet___s�_'_........... Total leaching area/ V._-___-sq. ft. z . Other Distribution box f K) Dosing tank ( ' ) aPercolation Test°Results Performed by.7 W�?_t�s.._��:_.1114.4.101 .GL.0-___--____-__ Date........ Test Pit No. 1__w__vr_0' _.__minutes per inch Depth of Test Pit....L_41_-_.-_..___ Depth to ground water.._.A-J-45.Ae f=, Test Pit No. 2_ !�..--__minutes per inch .D�th of Test Pit---` '_�_____ Depth to ground water---xt-00 l ' ---------------------- -'----- ` '----y .....................................••--- ----------•---------- 45� G Description of SoiL.._.-_ ? ,1+ 1" ..-_ ! 'A4, -`.-•----•------------------ x -- W I '° 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. j Si ed- G ••-- •------ 1 g � � ' Date Application Approved By------ � ------------------- Date Application Disapproved for the following reasons:--••---•---•....................•---•-•----------------------------------------••-•---------•-----•-•---•------- -:......-•----....-•--------------•-••-----•--......---------------- .......•-•----•-------•--------•-------------•----•-------•---------------------------•----------------------------------.----- k „ Date :.. Permit No........................... _ ------------------------------- Issued.---•---G1--- ................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD( HEALT C .=i ' ........ �_.................OF........ ........... L a/�:.............. ..t......................... Trdifirate of OrAotttph anrr THIS IS ITO CFjRTIE3Y,-That the Individual Sewage Disposal System constructed (41) or Repaired ( ) --------------- --- --- ----- ------- --------a---------------- --- r /. --- �staller - -•------ at., �t' .�•".:./b�!.� l/!!`:: ! f_-lti^ 1.J,! !<=6y` -- - ' •-••---�ii. 2_...!- L.�_cS�a_ :. ias been installed in accordance with the provisions of _ ficle XI .of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.7 k._.__.___/a______________ ................. THE ISSUANCE OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. G '� f�-� DATE--------------(.-1` / ----------------------...---------------.._. Inspector-------------------------- . -------------------------------•------•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD �- F HEALTH _ r.�°, .. jj� ............'� a -4-0 2........O F L -- �S c ....�...... ..:.. /�L..... No. .._... -••--._...... FEE--- ...... Bir o'gttl, r _q Cnumptrurtion rrrmit Permission is hereby granted_'_..l, -------- -------------------------------------------------Constr ct ,(�) or Repair ) an I dividua�l,,�SewagI Disposal S;teem �t _ ._.------- ---- Street as shown on the application for Disposal Works Construction Per, rt No.__._:__ Dated..._3 /7� Board of Health DATE............... ��--------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "<. _ T J. No........... •-••--• Fmc............ ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Applirtttiun -for Ui,ipuuttl Marko Tonfitrurtion Prrutit Application is .hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal r System at: - A. /..I...........................rs//<L c---------------------------------�: � / ' --- r _ Location-Address L or Lot No h 9 "�/, .-•------•• ....--•-- -• ........... 1..." ! lS O,yvner Address t _ p_. _ S feet � Installer � � Address d Type of Building Size Lot.... q. Dwelling—No, of Bedrooms--.-"'-�.____-_-.__-•______________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ---------------- ----------------- W Design Flow...... 0...........................gallons per person per day. Total daily flow...........-3_�_ .1�)--_--_--.-.--.._.-gallons. WSeptic Tank—Liquid capacitv_O�gallons Length...1_C"?...... Width._57......... Diameter---------------- Depth...... _._.... x Disposal Trench—No_ ____________________ Width............._------ Total Length-------------------- Total leaching area------------- ......sq. ft. Seepage Pit No..................... Diameter............... Depth below inlet---_.6----------- Total leaching area-I-7 I-------sq. ft. z Other Distribution box A) Dosing tank ( ) � _ aPercolation Test Results Performed by.. `!{ lw'.s.___ _r_...�-�..L4-%""�`::._..•... Date..._......�....?`'� ------------- Test 1 Pit No. 1...�_ _____--minutes per inch Depth of Test Pit..... Depth to ground water...... 10-A Gi, Test Pit No. ___minutes per inch Depth of Test Pit---- Depth to ground water'.A?4- -------•---------------------'.. = -------------- -•• - --------------- ---••-•-------------------------------•------ O Description of Soil-------- ��- 'a�'�' -"''' .-.4----.-t!'A!±� ---------------------------------------------- c4 ------------ -----------------------------------------------------------------------------------------------------------------------------------------------=----------------------------------------- W VNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -------------------------------------------------------------_...............•----------•......---••-'---•--.........------•-••--------------•..........------•---------•---....--------•------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with :he provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.- .....................................................( s.f �f r! f / t,J,,•�f.j / ( , p Signed---- G .... ........--- Date .Application Approved By-------- :--------------••-------- --------•---------.- - - -------- Date Application Disapproved for the following reasons:-----------------------------------•------------------•------------------------•-•-•-•__-.-•-•-•---•----------- ..................•-----•---•-•------•--•-.-_--------------•-•- -------------------------------•--•--•----•...•--••-•-••----------...-----•-••---.••••••---•--•---------------------....---...-----------•- Date Permit No......................................................... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD ' OF HEALTH. ; ' (Irdifirtttr of "'IT'llutpiittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) a Installer...................--'� t'I - ______ ________________________________ �___.._..__................._._. _...:__.___............_.......... 1 r has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nol._r---------- _____________ dated...............°-___-____r ` - THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE ,SYSTEM WILL FUNCTION SATISFACTORY. f -t'/'d y — t` I Gt/L 1 DATE ` - / - Inspector-----------"`-�-= .......................................... f............. 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :. ..........................................OF........ ------------..................--------------------•--......... 1'JO.............•----•--••-- FEE........................ �i��u�tt� rrrk,� �un�trnrtiu$t �rrutit Permissionis hereby granted----------------------------•----•--•--•--•-----•------------------------------------------------------•------------•--•-•------------------- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System i atNo...................................................................................................................................................................................... I Street a:s shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ----•-•.............•-----...-•---...--------------------------•----•--------.......-•----•----........_ Board of Health DATE-----------------------------------------------------------------------------•-- I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No......................... Flaic............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD. OF HEALTH .......... ... ... ..................OF...:..................................................................................... Appliration -for Dfspooat Workii Tonitrnrtion Vanift Application is hereby made for a Permit to Construct (' ) or Repair ( ) an Individual Sewage Disposal System at: •-•-•---••__----•`---••......................................•---•--•••-----•......•--•...••. .........•-•-------------•----•••-•--..._....-•••-•......----••--•--•--------•---•-••--...•----- Location;Address or Lot No. i .. /... .,......."� E -i.. !.. ;..�. Owner - Address r r Installer Address Q Type of Building Size Lot-- ':.................°%'__Sq. feet U Dwelling—No. of Bedrooms.--_-----___________-----------------------Expansion Attic ( ) Garbage Grinder ( ) pa-, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures .. Q -------------- ---------------------------------------------------------------- ..._ .._.... W Design Flow----- ____________________________gallons per person per day. Total daily flow..............................................................._.._gallons. WSeptic Tank—Liquid capacity_-._--___-gallons Length__►_'_:------- Width.... Diameter•------ Depth---------------- Disposal Trench—No- ____________________ Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter__.._.t:.......... Depth below inlet....... ............ Total leaching area........ --------sq. ft. z Other Distribution box (;^: ) Dosing tank ( ) Percolation Test Results Performed by—__..-.. --------------^______:r- ._:_.__.:____. ..____ Date.__._._....__ !___.__ __ W a Test Pit No. 1._ ........minutes per inch Depth of Test Pit....1_........... Depth to ground water.._-.........- ----- L=, Test Pit No. 2... _ ._._minutes per inch Depth of Test Pit.__ !!�"_--______ Depth to ground water-...r:f',1_.__,_'' 9 -----------------------------------------•------ ......................................................................................................-•- - O Description of Soil------ l " .' - ,✓ ...... = '- ------------------ x --------- .......................................•----------- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- V Nature 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.-�.....---•------------`----------'------ .='-.-•......'-------�'- A------ ----------•- ------�'--- :. .. Date ApplicationApproved By-------------------------------------------------------------------------------------------------- ------------•-•------ - ------------•-•- Date Application Disapproved for the following reasons:................................................................................................................ ........... --..--•--•-•------•-------------------------------••-••-•-•-•------•-----•---------•--•-----•----.._..----•--------•-••----••---•-----------.__..-----------._..._._....._..-------_---•. Date PermitNo......................................................... Issued------- ......./...................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......... ........................................................................... T.rrtifirnte of Tontphattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----•------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------•------------- Installer at..............--•-----------------------------•---•-------•--______---•--------•---------•---•_---------------•--••--•--------•--------------------------------•------•---•••--•-•---•------•-•--- has been installed in accordance with the provisions of Article XI 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. 4 DATE-------------..ZA/---- '---------------------------------------•-------- Inspector--------------------------------------------------------------;'----._._..._..---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................................... No.......................... FEE........................ Dinpaiial oxk Con trnrtfo$t rrutft Permission is hereby granted--------------------------------------------------------------------------------------- ------------------------- •-----------------•-----_---•- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo...................................................-..................................................................... ------------------------------------------ .......................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated-_--_--_..___----_---___._________________ ----•-•---------------------------------------------------------------•-•••----•---••-•••--------- - Board of Health DATE.................-------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /OD' � PE.L'co[/y:/O✓/ TEST= �../L 2%r .. ...---ter` J� pJNiL L._f GGPCY / LOCVS TdYT P,'r ! ` / LOT 12 �oH� eVA�A/VTJ _ I N�cF JJl) za zd---� .3 0-TLX '. ft¢t�.t} IS LO ! i r uAY T /7 0 r�'AT LCuE(... 2Coni 7I�-y �.11 .. _ ( �'"_-__.- _ P/"a==c'^'.5 n.a+✓.i... i LlJfALJTY M,Ap 1�4D25'� ft M r KF -14 - `_ -- ---- ; - - 'lr /oo' 4/0 10, J A S ,g'1✓. ./ �" :s!.v wr /"�V./TI L///��(/�✓C `n Y C � ._ R P,,:EL AST EON/✓, - � OrrT_ p' � C"L.,z3 scJ i za.07' 6[.a27.J7 - �J k � � SE'FTic 7A ti//•c �w lot ! E{ I ` 102L O C A T to SEWAGE PERMIT NO. VI LAGS rea—�eTzlzLle - &-�� A — INSTALLER' NAME i ADDRESS 3UIL0ER OR OWNER DATE ' PERMIT ISSUED 3 _ 7- -7d- DATE COMPLIANCE ISSUED - y- If- - _� �i ;� , , 1. I � t' .,, � � II �. i� ,� � � ��', s �