Loading...
HomeMy WebLinkAbout0094 COTTONWOOD LANE - Health 94 Cottonwood Lane Centerville P A = 252 150 IN UPC 17534 0.2 '�sxco ' KASTINOS.UN 1 .. No. v �e3 Fee 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a/ Yes .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppliCation for Nsposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System X Individual Components Location Address or Lot No. Q q(S CD A,C-V 1 U g— Owner's Name,Address,and Tel.No. �> tcS C,�4Y�u Assessor's Map/Parcel �22. o ©&9 A0A d"V'u6 P®160 �jg Ge_-WreV_U (L_E Kam( Installer's Name,Address,and Tel.No. 50$-41Z-$$'11 Designer's Name,Address,and Tel.No. dAf6uADE �� SU5 N14 Type'of Building: Dwelling No.of Bedrooms f 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 Nature of Repairs or Alterations(Answer when applicable) L,(jy r— G&fALG-4= NQuS& 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 ealth p Signed Date 6 ' ✓ Application Approved by e Date � — Application Disapproved by Date for the following reasons Permit No. ®� 0 Date Issued �3ad 5 No ! 'I °. _ I -Fee �"""y✓ - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ �11� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplicatlon for Mispo8al *pstem Construction Permit Application for a Permit to Construct( ) Rep!im(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. GRAi Owner's Name,Address,and Tel.No. wo 6v t QA4al �A =A&KGS C.AVAUGLta Assessor's Map/Parcel 2a.�' 008 BOA C,V'"--` AO SOX a084 � 't`KV l[�.�► K Installer's Name,Address,and Tel.No. .5p$-4-11 Designer's Name,Address,and Tel.No. G ?6Wj1 AE a.JgE4*01 SES NlQ Type of Building: A r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures I / �y Design Flow(min.required) ��/ /t 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 Nature of Repairs or Alterations(Answer when.applicable) L l N C— GIoNC-O 7) -TAO K 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. p Signed / Date Application Approved by Date f Application Disapproved by Date for the following reasons Permit No. Ol r - 3 ,70 Date Issued / °7l`- 7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .v tj Certifitate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by ,�A TC-W Lh E 9&)76-:`R1 9J 5: at �qL; ra0(fC--VILLC- �_,�4CbE Q'b <�U[LL.E ias been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.aQ���je�fJ dated r Installer Q A P (�q t OC-� IV •t��J`-S� Designer A f .#bedrooms nI/7 Approved design flo. A gpd The issuance of this pe�fmit shall not be construed as a guarantee that the system willrfunctias designed. f) Date aT ( Inspector =� 1 1 . . , 'Ili No. �a� � V Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MI8po8al 6pstem ConBtrUttion Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at q 4(2, C441 t-� I1 n*-'a P.oef% C. V I t„Lf-.- 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.-lam � 0/� Date ` ) 1 r Approved b PP y r 1 Cf COMMONWEALTH OF MASSACHUSETTS , EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL Pa y'gy(���`.Y04TABLEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 94 Cottomvood Lane Centerville, MA 02632 MAP � Owner's Name: Aaron Hill PARCEL Owner's Address: LOT Date of Inspection: March 3, 2004 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:\subm Date: March 8, 2004 The system inspector shcopy 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 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Cottonwood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 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 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 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 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A CERTIFICATION (continued) Property Address: 94 Cottomvood Lane Centerville, AM Owner: Aaron Hill Date of Inspection: March 3, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less 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,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. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 Cottornvood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 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 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 94 Cottonwood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 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: 94 Cottonwood Lane Centerville, AM Owner: Aaron Hill Date of Inspection: March 3, 2004 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: 0 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: Unknown 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: Unavailable 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: A new D-box was installed in 2000-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Cottonwood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 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: 15" 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: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 10" 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.): Tees were present. The liquid level was even with the outlet inert. There did not appear to be any signs of leakage. 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: 94 Cottomvood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 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: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level and clean. No solids were present. 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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) Property Address: 94 Cottonwood Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) 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.): The nit had 6"ofwater on the bottom. There did not appear to be any signs offailure. The bottom to grade was H'. The cover was 4"below grade. 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: 94 Cottomwod Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM 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. r'1 D I Q a(0 a� a a 3a 33 3 3 Sy 31 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 Cottonwod Lane Centerville, MA Owner: Aaron Hill Date of Inspection: March 3, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 45 +/- 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 45'+/-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. tl TOWN OF BARNSTABLE LOCATION CMAWQUC /14AA- SEWAGE # / VILLAGE t" >lb- ASSESSOR'S MAP & LOT 0 -- /5O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 020 LEACHING FACILITY: (type) (size) �« NO.OF BEDROOMS BUILDER OR OWNER- AA1-0 PERMITDATE: 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 leas ng facility _,,, Feet Furnished by 1Oc On ,. FO/ a 3a 33 3 3 Sy 31 . ={ -= COMMON WIEAL'1'II OF MASSACHUSIs'1"i'S EXECUTIVE OFFICE OF ENVIRONMEENTAL AFFAIRS -- - DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 2.92-5.500 350 MAIN STREET TRUnY COXE Sec retary WEST YARMOUTH, MA ARGEO PAUL CELLUCCI 508-775-2800 DAVID R. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION MAP 252 PAR 150 PROPERTY ADDRESS: 94 COTTONWOOD LANE, CENTERVILLE ADDRESS OF OWNER: DATE OF INSPECTION: JULY 27, 2000 TONY TRIPODI NAME OF INSPECTOR : JAMES D. SEARS I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.000) COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth,MA 02673 TELEPHONE NUMBER: (508)775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: DATE: AUGUST 7,2000 The system Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(30) days of completing this inspection. If the system is a shared system or has a design now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. NOTES AND COMMENTS: SITE OVER ALL PASSES,INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIVICATION (continued) Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 INSPECTION SUMMARY: Check A, B, C, orD: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below., COMMENTS: B SYSTEM CONDITIONALLY PASSES: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The System,upon completion of the replacement or repair,as approved by the Board of Health will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate Of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pa pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 COTTONWOOD LANE,CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303 (1)(b)THT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: , Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen and is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 94 COTTONWOOD LANE,CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 D] SYSTEM FAILS: N/A You must indicate either"Yes"or"No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 16.303. The basis for this determination is identified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: N/A You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system 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 mapped Zone I I of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site Has been determined based on: X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. revised 9/2/98 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms(design) 3 Number of bedrooms(actual): 3 Total DESIGN flow Number of current residents: 0 Garbage grinder(yes or no): NO Laundry(separate system) (yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no): YES Seasonal use(yes or no) NO Water meter readings,if available(last two(2)year usage(gpd): 1999 128,000!2000 33,000 Sump Pump(yes or no): NO Last date of occupancy: N/A COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Gpd(Based on 15.203) Basis of design flow 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: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract. Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 1983 NEW D-BOX 8-4-00 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 COTTONWOOD LANE,CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction _ cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: X (Locate on site plan) Depth below grade: 10" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined AS BUILT AND TAPE Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) MAIN TANK AT WORKING LEVEL,TANK AND COVERS 10"BELOW GRADE,OUTLET BAFFLE. GREASE TRAP: N/A (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: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) revised 9/2/98 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI,TONY Date of Inspection: JULY 27,2000 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or 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 Alarm level: Alarm in working order Yes; No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS NEW,9"X15",2'BELOW GRADE.ONE LINE IN,ONE LINE OUT. PUMP CHAMBER: N/A (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.) revised 9/2/98 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI, TONY Date of Inspection: JULY 27, 2000 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not located, explain: Type: Leaching pits,number: 1 Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) ONE(1)1,000 GALLON PRE CAST PIT,PIT 4'BELOW GRADE.COVER Z BELOW GRADE,4"WATER IN PIT,WALLS CLEAN. CESSPOOLS: N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure, ,level of ponding,condition of vegetation,etc.) PRIVY: N/A (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.) revised 9/2/98 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI, TONY Date of Inspection: JULY 27, 2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100'(locate where public water supply comes into house) tr✓ 0 ,5fl revised 9/2/98 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94 COTTONWOOD LANE, CENTERVILLE Owner: TRIPODI, TONY Date of Inspection: JULY 27, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Ground water depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) LOT HIGH, NO GROUND WATER PROBLEM. revised 9/2/98 11 No. r/�Q ( Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppricatton for 10i5pog l *pgtem Congtruction Permit / Application for a Permit to Construct( )Repair(YUpgrade( )Abandon( ) ❑Complete System 4VIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 9Y C®�A/ Assessor's Map/Parcel y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. cv r 7�/P 7 �s 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) P?f P,46tC£ 0-k L I.v 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 Certifi- cate of Compliance has been is ed by this Board of Heal Date Signed Application Approved 001 Y Dated Application Disapproved for the following reasons Permit No. r"' Date Issued No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Z(ppYication for Miopooal br6tem Conotruction Permit Q/ Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System 4windividualCompon,ents i Location Address Lot No. Owner's Name,Address and Tel.No. t ., Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 19,E C G 3 s,a I� 4V 4 �0/f 9 9, ,-02 row 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 Certifi- cate of Compliance has been is , ed by this Board of Heal Signed Date r Application Approved ' Date 24Z?s Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS . Certificate of Compliance THIS IS TO CE TIFY,that the On-site Sewage Disposal System Constructed( )Repaired`(�K)Upgraded( ) Abandoned( )by ViA OdATO 34­0 4Y ' 11- -,.400,4/1 at 9I Y CA-IZo-.e A0 4 i.2) -4 " C r has been constructed in accordance with the pjdv^nsions of Title 5 and di r Disposal System Construction Pe l �dated 4 ." L j Installer Designer The issuancpaof this pemqt shall not be construed as a guarantee that the sys ill functio as de'g�'e` Date ,C� b Inspecto J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Iigo0ar *ptem Congtruction Permit Permission is hereby granted to Construct(•. )Repair Upgrade( )Abandon( ) System located at r Q 71.0 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. zP..�„+. Date: --7 40 ,_ Approved by ., i 150 TOWN OF BARNSTABLE v LOCATION ('O la xv0d) ,l^. SEWAGE # VILLAGE C ASSESSOR'S MAP 6i LOT INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size). . NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER - BUILDER OR OWNER DATE PERMIT ISSUED: t� j. DATE COMPLIANCE ISSUED: VARIANCE.GRANTED: Yes No 1. eg 4 3 0 _ TOWN OF BARNSTABLE LOCATION �! C90 lore dv®a3 JA• SEWAGE # C �ti� VILLAGE ASSESSOR'S. MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS ,PRI�V/ATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 3�r/ N ' VARIANCE GRANTED: Yes No O �c2(. oZ� r 3,9. - �,. °33r 0 YR TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP 6z LOTca—i 01� - /�5"o_v i%f1'S 'S NAME fa PHONE NO. A & B CANCO 775-6264 `'SEPTIC TANK CAPACITY _LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O OWNERQ�� DATE PERMIT ISSUED: -�- DATE COMPLIANCE ISSUED; VARIANCE GRANTED: Yes No r. s 33 ' 0 No... 3 f7 Fis....l... ............... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD (�OF HEALTH �.3 I ... ... ........OF.........1 �'�f''1��� � ................................... Appliratinn for M-4p gal Workii TPnotrnrtinn ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: - _ - --...... Location-Address or Lok No. + Cam: . ------ .!.1a r :Ce�V' ke_ Owner Address a Q ................ .... ................................................... --••-----••-•-••---•••-•••-•••----•.........-•-•--•-••--•--••••-•------•--••--••--------------•••- Installer Address d Type of Building Size Lot.1q.-0®..........Sq. feet V Dwelling—No. of Bedrooms____'1�� .......................Expansion Attic (✓) Garbage Grinder ( ) Qa, Other—Type of Building ------ ............ No. of persons-------V :n�------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------• ----------•--•----•-••••---•--•-- W Design Flow............5.5------------------ ----gallons per person per day. Total daily flow-------;�RQ.........................gallons. W° Septic Tank—Liquid capacitv:!nP-P---gallons Length_S'..... Width.�i'A®".__ Diameter__ /A------ Depth_5 x Disposal Trench—No. .___O/R........ Width.....!�Md�....... Total Length.._.!9/eP....... Total leaching area..._N/R.......sq. ft. Seepage Pit No--------1----------- Diameter......1.0.......... Depth below inlet.._...�R`r........ Total leaching area..L?......sq. ft. Z Other Distribution box (,✓) Dosing tank 01i1N)Percolation Test Results Performed by... ................................. Date-(,/ 83................... aTest Pit No. 1_ ......minutes per inch Depth of Test Pit----- _'Zr_........ Depth to ground water._!! ° ......... Test Pit No. 2.4�._._..minutes per inch Depth of Test Pit.......?.?-....... Depth to ground water____N .'�-..._._. -------------------------------•---•----------------------------•-.........................-----•--•.............................................. O Description of Soil.....a "� L GArn t-��'(� a --i--- " ------�"=►A�i--------���y��� �Gc� � j ►� - , Mec �v Win• C. M A `.... �..� ice - inu�� 2 0`L 1 +tea a�� V •--- -• . ------•- ................. _..'-�-z---M��_'_�rn_-wn�.p e> e n . .......... 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:T T y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. S" ed _.. VIC-V 7 _.. . Dat Application Approved BY ••••..••-• .._ v (/ Xate Application Disapproved t following reasons-----------------------------•-----------------------------------------------------------------------..........-- ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date 9 .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w.. OF........... .r�5 �n..s:f Appliratiott for Elhgp sal ?forks Tomitrurtion Vanfit Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal System at: ..._...... ......... ...... .... •---•--------- ...._..-- -••--•-------- Location-Address o Lot N Q-A MA Owner Address e.. ----------------••------------------------ --------------------------------••---•--------.----..--•--•--------------------------------------- I taller IAddress (� Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..... .....................Expansion Attic (K) Garbage Grinder ( ) Other—Type of Building ______�1 .......... No. of persons............ ........... Showers ( ) — Cafeteria ( ) aOther fixtures ......................................................... W Design Flow........S 5.............................gallons per person per day. Total daily flow__-____----33 ._...._.___......_.._.gallons. WSeptic Tank—Liquid capacitykQq .gallons Length Z'_�'_�_.._ Width4r.`0" � A -_5"`52. Diameter_ � ..... Depth "_.. x Disposal Trench—No. ___NZR....... Width...1?Zlot._.... Total Length......!�ZA_.... Total leaching area.._W-A.. sq. ft. Seepage Pit No........l------------ Diameter......�O` ._.. Depth below inlet......4x.......... Total leaching area.ZWP....sq. ft. Z Other Distribution box (v-1 Dosing tank ( ) _ ~' Percolation Test Results Performed by.... 1�_1_ __`- .A.� ? ............................. Date... .......... as Test Pit No. 1--- ....minutes per inch Depth of Test Pit....... ...... Depth to ground water...d'--Q ...__. (i Test Pit No. 2--- Z....minutes per inch Depth of Test Pit........12s_..... Depth to ground water.....�_'V__o" -__. a ...................................................................................................-............I.........------ .......... Description of Soil ?� *'n... ©�s 6; ' . �lJ---�-----M e.�_��-n----- c �p r x �-- ...__.f.1SaCll-J ..........MQ4 _• h�•/....-- sG _M...1,. 2 S Y���'=� ----------------- U ..................... Q k 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'T`TL p 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 ed� &-------------------------------00 T ... Date Application Approved By ` d '�' ---------------------------•-•-------••-•-•-----••---------•-•-•-- V -�� Date Application Disapproved f t following reasons--------------------------------------------------------------------------------------------•••-••••------------- ..................................................•-----•--------------•------•----•--....--•-------------------------------•-------•---------------•-------------------------.... -----•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...}.. �d.l••......................OF.........C..»."..t":.9.F..f.•F..:...?.. ..ri".^.!:"� .�. ........................... (Crrtifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) by-- � ::.l / Installer at----- - Lk,.4.......... ----- C has been installed in accordance with the provisions of Tl�' r' j of The State Sanitary Cod,,r�e' ribed in the application for Disposal Works Construction Permit No.._ .'. - ,t............. da.ted_.. .�.._....._._...... r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTPgR AS A GUARANTEE THAT THE SYSTEM WIl L F NCTION SATISFACTORY. DATE..... � /-. -•------------------------•-----•-----------•--•------ InspectorrACHUSETTS ...........................-----.............................. THE COMMONWEALTH OF AS BOARD OF HEALTH .s.�`.. .................OF....... ............................. No "....... FEE........................ Permission is hereby granted----- ----- .....................-......................................................... to Construct or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No............... .--- __ ---,--------_-------- lI and of Health DATE---------•--......-••-•----••-S/.../� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS L0Ck-TION -*q4 SEWAGE gP�ERMIT NO. Lot 164 Cottonwood Lane VILLAGE Centerville, Mass. z �� S INSTA LLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd,. North Harwich, Mass. BUILDER OR OWNER McKeon Custom Homes DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �a �� 1 ��3 � + - � � 3� � ?�" . �� 1 1 .r 7 PNOW L&Y►C+rrwL' Ico1l log »If . fwl m or. !!03) 03 03 Sam Tvw jpo,8 �pZ.2 iV lol 9-rtz. � Q POST Ewe.P•57 OFM �� Jk E MOF�3 MOR y �Xcsr►...G �.4v�nirC�.r SE P NO.10951�0007 1 .0-"�:"V,100D L le� N a� -SIpPJAI/ pryer__� Nth 4Z D- l l.(! Zol.o 00 / nK I Zs` r n rrr �C 3 S tD� n gay._ I o'r• . E R SSuri or; . LEGEND � EXISTING SPOT ELEVATION Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR---. 0 --- tN of Al FINISHED SPOT ELEVATIONgo o p`�, LoT l��/ L.�, 0C-% 239 C FINISHED CONTOUR 0 BR?U ` e�ucE � f APPROVED ' BOARD OF HEALTH EIQRE y IN { �AJlA8TA,3 L i1,,bJASS. DATE AGENT ND s1;, SCALE, / =3a DATE, 7 /9 83 DREDGE ENGINEERING Ca IN�G'j /r')� ,;� CLIENT:._......_ I CERTIFY THAT THE PROPOSED LENGI- ISTERE REGISTERED JOB NO. 83. . BUILDING SHOWN ON THIS PLAN IVIL LAND CONFORMS TO THE ZONINGC� LAWS EER-Q "RVEYO DR.BYs. e.: ..,..... OF BARNSTABLE, MASS. (we-r4S^«el) 712 MAIN STREET CI. BY a rl A � 83 ���`�'�R-.�"• /�/�.' HYANN I S, MASS. 10 SWEETJ— OF .—ZJ_�DATE REG. LA ND SURVEYOR 5: NOTE : /� E/ TNL•R ZI S�P7"I C TAN�C OR 2Q ITT_ IAf _FAGt,I/NG. P/T 4.Re MORE T •! /2 BELOyv j,4A0E�A 24�DlA.N FTER CONC?ET,5 'COVER i JO RT M/� 5,4.4LL eF 9Q0t1GX7 " CO/VC.t�rE . y•PYG PIPE �110E.4VY CAST /RO/1/ COVE.? Sh+ALL 3E 4/54F �o3>S "/IV P/TC14 /F!N DR/VE i1/A Y ' COY4E" yj',vFp FT. t 2 • +f �-^ CDNC Z TE 1 AF /17 �, LJQV 2 LAYER /1B0111t P/PE.. 1�0 0 �TwL� - • 1 • • • • • •• • e ••. yyA S t/=0 57Ti NE i MJN.P&40 -. D15T. • * . • • . • • • • a • �OpTt.o ,� •f • • •• •EFl=ECTlYL •• • • •• 3f4 /2Y• • p • • • • • . 1V.4S.�iED STONE • EP ,H ip r�s 9 x :6� Z`f 2. • , • • . . . , PRECAST SEEPAGE F 7T'�M l53.9 ac4i..7/ J /09.3_ s�.• • • • • • • • . , ' e P/7 OR EQlJ/V, Ary4eA7 &L i f6l-3 6PD IXYF.RT.AT'OtlltD/NQr °O•S_ ` # _ prrc �.�Y .� `I �SFE TAdLJLAT/ON, ,IX[ET:.SEPTA Ti+N�f 3 � �.r Ep 1CTit14tic ° - 1- ;. O(JTtAT S K c •. rrsepLNa' J'�lATEa� TitdLE INL&-'D/ST.4V,9 �oAIy l�GIAI _ • .�L�G7"1014`.CIS �' pNTt.EFp/3TR1BtlJGX .SrPI�Atsi ` �/SPSAL SY,S7, F/►9: Ti��LLATIBJ'1� de�t4ff :/4 IF• 4 Ivy�raeR oFe��voHs - - SOlL LOG � _ GARGVtGE'DISPOS/IG UX/T�— -. SQlL TiE3T ; TaT.�t ES'rl/►9RrFD F/A.w 33o G.�►t./Ltitt� 50I L TEST Alf SO/C TFST� t ACC✓. • Y• L�•4TLw OF S®lL TgST NU MBER 4F Lfi1CMtN& PlT3 /03 ELE l• —� �` !•T �/•;/acer3/, J t i SIDE LEACHJKG PER P!T l s.9 s , ja,ti 1;ESULTS e,/1T/VESSED dY BOTTOM LE�iCNING PER PIT 53' SO. FT S�gs•�� PERCGLIIT/ON RATgI — Ml/VVINCH TOTAL 4Z4CN//yG AREA 3Z9•$ s'4 FT. �RCOLATION RATF 2 M!�/.�INCI,► fo 5 D�5/G ti J ►Z[ T2dhZ� Or <o M�v�jw n,Ea.5<Y✓D aFSERVEZEACNrmd AREA S4 T.- F p�z sr t�. .4c •rr 1 ty fN�Of sS �H M �dm . .. -- �r� ROBERT 02 - �IBERT ��, `�� eRucE A. �, EL DREDGE FiVG/IVEERIJyG CO,ING. ELDRED "' o . ,MORSE v� � No 10951.�00- _ � ,9/,YLi -712 )VI A-f V ST. , �yYgN.viS, MASJ. `c►sTs� �O�/ 90 FGISTE� ��s� �Qf N�G�OUN{7 yv.4TCR fl�/G'ouiYTf�Eo CL/ENT:I(ctK�"•► DRTE `Z �4^1) StS � FFS��CNM- Q GROU/VO itiATER AT ELEV. — JOD ND.' 13= SHEET?OF ?