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Home My WebLink About1195 FALMOUTH ROAD/RTE 28 - Health { 1195 Falmouth Rd eta 229-100-001 Centerville i i 1/11 UPC 12543 No. 53LOR HASTINGS, MN i 1 9 9 7 i O 3 j i t a a i �yy 9 3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS n � DEPARTMENT OF ENVIRONMENTAL PROTECTION A F yyA� V¢I� 5yey TITLE 5#2007310 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust ^ Owner's Address: 2036 Washington Street,Hanover,Ma.02339 l ` Date of Inspection:. December 11,2007 Name of Inspector: Arthur Bloomquist www.titievinspections.com Company Name: Arthur Bloomquist Mailing Address: 109 West Street J 1 Plympton,Ma.02367 / 1 a 1 00 Q I Telephone Number: 1-877-291-1066 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the inforr3ation reed below is true,accurate and complete as of the time of the inspection.The inspection was performed b�sed on m training and experience in the proper function and maintenance of on site sewage disposal systems.I am a=rj �•y approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The systems-:. ' x Passes Conditionally Passes � ds Further Evaluation by the Local Approving Author ty - Fa' � Inspector's Signatur • Date: December 12, 007 - The system inspector shall su mit�a—copyy of this in report to the Approving Authority(Board Health% DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flo 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 The septic system is functioning well. The tank does not need to be pumped at this time. Always pump from the outlet side of the septic tank so that the tee and can be inspected. Additional information about the use and care of a septic system is available at www.mass.gov/dep/water/wastewater/yoursyst.htm and www.titlevinspections.com . Water conservation is the best way to extend the life of a septic system. Excessive water use will cause the septic system to fail! The capacity of a septic system to safely treat waste water diminishes with use. Old systems must be treated with care even if they pass this inspection. This inspection is not a warranty that the septic system will work in the future. ****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: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: x 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:_The septic system is in excellent condition. There are no indicators that it has failed in the past. 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: 1195 Falmouth Rd,Centerville. Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 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: ' Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool x 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 n/a_ _ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow _x 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. n/a _ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. n/a_ _ Any portion of a cesspool or privy is within a Zone 1 of a public well. n/a_ _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. n/a_ _ 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 thikform.] nc (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 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. 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 11 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. T,.,. r__. . r...... .,, 4 ' Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 Check if the following have been done.You must indicate"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_ Were any of the system components pumped out in the previous two weeks? x_ _ Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of this inspection? x _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x _ Were all system components,excluding the SAS, located on site? x_ _ 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? x_ _ 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 x _ Existing information.For example,a plan at the Board of Health. _x_ 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)] ' Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):— Is laundry on a separate sewage system(yes or no):_ [if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use:(yes or no):_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):— Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Bank Design flow(based on 310 CMR 15.203): 620 gnd Basis of design flow(seats/persons/sgft,etc.): square feet Grease trap present(yes or no):—no Industrial waste holding tank present(yes or no):—no Non-sanitary waste discharged to the Title 5 system(yes or no):—no Water meter readings, if available: 68.49 Last date of occupancy/use: current OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: owner Was system pumped as part of the inspection(yes or no):_ no If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM 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) _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: 27 years Were sewage odors detected when arriving at the site(yes or no):_no_ -_. _ r. 111a„1 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: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 BUILDING SEWER(locate on site plan) Depth below top of foundation: inaccessible Materials of construction:_cast iron _Schedule 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): inaccessible SEPTIC TANK:_(locate on site plan) Depth below grade: 130 inches Material of construction:_x_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: 4x5x8 Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle: 32 Scum thickness: 0 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: 15" How were dimensions determined: estimated Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank is in good condition. There is no need to pump the tank at this time. GREASE TRAP:_(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.): �,_... r....._ , 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: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box is in excellent condition. There are no indicators that it has failed in the past. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: The pit is in excellent condition. The level of the effluent was 6 feet below the invert of the pipe. Type x leaching pits,number:_1 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.):There are no indicators that the system has failed in the past. It is in very good condition. 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 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: (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: 1195 Falmouth Rd,Centerville Owner's Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 __ __Date_of Inspection;._ December 11,2007 i .. 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Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1195 Falmouth Rd,Centerville Owner's m • O e s Name: Rockland Trust Owner's Address: 2036 Washington Street,Hanover,Ma.02339 Date of Inspection: December 11,2007 SITE EXAM Slope 0-1% Surface water Long Pond Check cellar dry Shallow wells non available Estimated depth to ground water_30_feet Please indicate(check)all methods used to determine the high ground water elevation: _x_Obtained from system design plans on record-If checked,date of design plan reviewed: 6/26/80 _x_Observed site(abutting property/observation hole within 150 feet of SAS) _x_Checked with local Board of Health-explain: I reviewed the folder at the BOH Checked with local excavators, installers-(attach documentation) x Accessed USGS database-explain:_well MIW 29 ow max 5.6 ow current 9.74 11/29/07 You must describe how you established the high ground water elevation I augered a hole to a depth of 20 feet and found no water. This is consistent with the soil log that was done in 1980 and the elevation of Long Pond. tNE Tp� Town of Barnstable OF Regulatory Services BaRxnB Thomas F. Geiler,Director MASS. 9� s63q �0� Public Health .Division Arfp�,�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. / TOWN OF BARNSTABLE LOCATION �! �cS� �i��riu G� SEWAGE# l / VI LAGE ASSESSOR'S MAP&PARCEL LLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L 13vA4 COMMONWEALTH OF MASSACHUSETTS 10 EXECUTIVE OFFICE OF ENVIRONMENTAL AF�FAS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108(617)292-5500--e ® P�n ro" TRUD zl /Y�GOXE ahvu �cr.etary ARGEO PAUL CELLUCCI DAVID'B�STRUHS Governor 1Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1195 RT 28, CENTERVILLE,MA. Name of Owner FLEET BANK (DEBORAH POOLE,MGR.) Date of Inspection: DULY 26,2000 Address of Owner: Name of Inspector.(Please Print) LLOYD D. SIME I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Mailing Address: 396 South St.Bridgewater,MA.02324 Telephone Number. 508-697-6663 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority LJ Fails inspector's Signature: Date: July 28,2000 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 flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS 1.)RECOMMEND THE COVER OVER THE OUTLET END OF THE TANK BE REPLACED WITH A STEEL COVER. THE CONCRETE COVER HAS SOME CRACKS ON THE UNDERNEATH SIDE.THE RISER OVER THE TANK IS ELEVEN( I F)FEET TO THE TANK. revised 9/2/98 Pagel of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1195 RT 28, CENTERVI LLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: ® I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. 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 failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying 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 pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 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 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)THAT THE SYSTEM I 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 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 I 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 is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER El revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: NO I have determined that one or more of the following failure conditions exist as described in 310 CMR 1 5.303.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 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 1/2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑ ® Any portion of a 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 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 1 00 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: 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: The system serves a facility with a design flow of 1 0,000 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 m IWPA)or a mapped Zone 11 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 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No ® Pumping information was provided by the owner,occupant,or Board of Health. ® None of the system components have been pumped for at least two weeks and the system has 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. ® As built plans have been obtained and examined. Note if they are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up. ® F1 The system does not receive non-sanitary or industrial waste flow. ® Fj The site was inspected for signs of breakout. ® All system components,excluding the Soil Absorption System, have been located on the site.l ® 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: ® Existing information.For example,Plan at B.O.H. ® Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] ® The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. I revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design): Nu r of bedrooms(actual): Total DESIGN flow Number of current residents:_ Garbage grinder(yes or no):_ Laundry(separate system)(y or no):_�If yes,separate inspection required Laundry system inspected( s or no) Seasonal use(yes or no): Water meter readings, if vailable(last two year's usage(gpd): Sump Pump(yes or no Last date of occupanc COMMERCIAL/INDUSTRIAL: Type of establishment:BANK Design flow: gpd (Based on 15.203) Basis of design flow Grease trap present: (yes or no) NO Industrial Waste Holding Tank present:(yes or no)NO Non-sanitary waste discharged to the Title 5 system: (yes or no)N Water meter readings,if available:NOT AVAILABLE Last date of occupancy:current OTHER: (Describe) Last date of occupancy:OCCUPIED GENERAL INFORMATION PUMPING RECORDS and source of information: NOT AVAILABLE System pumped as part of inspection: (yes or no) NO If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM xxx 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: RUNE 26, 1980 PERMIT# 80-239 Sewage odors detected when arriving at the site:(yes or no) NO revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: DULY 26,2000 BUILDING SEWER: (Locate on site plan) Depth below grade:144" Material of construction: cast iron❑40 PVC❑ other(explain) APPEARS TO BE CAST IRON IN THE BASEMENT FLOORS, ALL PIPES ARE BUILT INTO THE WALLS AND THE FLOOR. Distance from private water supply well or suction line 30+' Diameter 4" Comments: (condition of joints,venting,evidence of leakage,etc.) WHERE OBSERVED,APPEAR TO HAVE NO EVIDENCE OF LEAKAGE. SEPTIC TANK: (locate on site plan) Depth below grade:130" t., Material of construction: concrete❑metal❑Fiberglass aolyethylene❑ether(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions:S X S X 8' Sludge depth:I-2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle:13" Distance from bottom of scum to bottom of outlet tee or baffle:13" How dimensions were determined: MEASURED 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.) THE INLET TEE AND OUTLET BAFFLE APPEAR TO BE IN GOOD CONDITION.THE LIQUID IS AT THE PROPER LEVEL IN THE TANK,(EVEN WITH THE OUTLET INVERT).THERE IS NO EVIDENCE OF LEAKAGE. DUE TO THE DEPTH OF THE TANK,AND VISIBLE CRACKS IN THE CONCRETE COVER,I RECOMMEND THE TANK COVER ON THE OUTLET END BE REPLACED WITH A STEEL COVER. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: concrete❑metal[]Fiberglass olyethylene❑)ther(explain) Dimensions: Scum thickness: Distance from top of scum t/condition baffle: Distance from bottom of sc tee or baffle: Date of last pumping: Comments: (recommendation for pumpind outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1195 RT 28, CENTERVU LE,MA. Owner: FLEET BANK Date of Inspection: JnY 26,2000 TIGHT OR HOLDING TANK: (Tank must be pumped prior to,or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:Lj cast iron❑40 PV other(explain) Dimensions: Capacity: gallons Design flow: gallon ay Alarm present Alarm level: AI in working order:Yes❑ No❑ Date of previous pumpi Comments: (condition of inlet t condition of alarm and float switches,etc.) DISTRIBUTION BOX: OK (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) UNABLE TO FIND A DISTRIBUTION BOX DUE TO THE DEPTH OF THE TANK AND DEPTH OF THE PIT.LIQUID FLOW TO O THE PIT WAS NOT BLOCKED OR INTERRUPTED..THERE WAS AT LEAST FOUR FEET(N)SEPARATION BETWEEN THE INVERT OF THE PIPE FROM THE TANK AND THE LIQUID LEVEL IN THE PIT. PUMP CHAMBER: ❑ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamb ,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:, 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26 2000 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type' leaching pits, number-2 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.) SOILS ARE DRY,NO EVIDENCE OF BREAKOUT(THE TOP OF THE LEACHING PIT IS ELEVEN FEET BELOW GRADE). THE PARKING AREA AND LAWN OVER THE LEACHING PIT IS DRY, THE BOTTOM OF THE PIT IS 17-8' DEEP.THERE IS 48"BETWEEN THE END OF THE PIPE AND THE LIQUID LEVEL. THE PIT APPEARS TO BE FUNCTIONING AS INTENDED. CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow(cesspool must be umped as part of inspection) Comments: (note condition of soil, gns of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: 11 (locate on site plan) Materials of construction- Dimensions: Depth of solids: Comments: (note condition of soil,signs of raulic failure, level of poncling,condition of vegetation,etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) aa �v - 1 13 ;Iz "-o revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1195 RT 28, CENTERVILLE,MA. Owner: FLEET BANK Date of Inspection: JULY 26,2000 NRCS Report name SOIL SURVEY OF BARNSTABLE COUNTY, USDA SOIL CONSERVATION SERVICE. MARCH 1993 Soil Type CcA -CARVER LOAMY COARSE SAND. Typical depth to groundwaterOVER 6' USGS Date website visited JUNE 23rd WATER LEVEL BELOW =24.21 Observation Wells checked BARNSTABLE(AIW)230 OWmax 20.51' Groundwater depth:Shallow Moderate Deep 24 21' SITE EXAM Slope 0-3% Surface water NONE Check Cellar DRY, NO SUMP PUMP Shallow wells NONE Estimated Depth to Groundwater 18-20 Feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ Obtained from Design Plans on record ® Observed Site(Abutting property,observation hole, basement sump etc.) ® Determined from local conditions ❑ Checked with local Board of health ❑ Checked FEMA Maps ❑ Checked pumping records ❑ Checked local excavators,installers ® Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) Loe-&l 6o l;fioo revised 9/2/98 Page 11 of 11 LA CATION SEWAGE PERMIT NO. VILLAGE T— INSTA LLER'S NAME i ADDRESS OR WN ER ` _2 lc DATE PERMIT ISSUED 9 ' ` DATE COMPLIANCE ISSUED 4 r1 V M6 1 s ... c r f BAXTER & NYE INC. Registered Land Surveyors and Civil Engineers 7 Parker Road( sterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,RL.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering January 16 , 1987 Board of Health Town of Barnstable P.O: Box 534 Hyannis, MA 02601 RE: Septic System SentrY Bank W. Main/RT 28 Centerville 85129 Gentlemen: This letter shall certify that the septic system has been installed in strict conformance with the design. A design addition of a paved sluce was not represented on the original plan, however, the sluce meets all state and town. standards. I trust that this meets your present needs . Very' truly yours, Peter Sullivan, P .E . Baxter & Nryryye, Inc. "•��N OF PS/fmj ,�. /ISS9cy CC: Sentry Bank PATER SULLIVAN No.29733 FFSS�ONAL MEMBERS OF GAPE COD SOCIETY OF PROFESSIONAL ENGBVEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACNUSSTlS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS Fee---- -=Is----------- BOARD OF HEALTH TOWN OF BARNSTABLE Application Ar Veil Congtruction Permit Application is hereby ma�de_�f/or�a pppermit to Constryct� ), Alter ( ), or Re�air ( )an individual Well at: Location — Address -- Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building Dwelling-------- — —-- — Other - Type of Building---- --------- No. of Persons------------------------- Type of Well-------- ----- - Capacity--- - -- ---—— --- —_-- Purpose of Well -- �'- FG ! ------ Agreement: The undersigned agrees to install the aforedescribed individual well.in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed !3--2 —----— — - —date----- Application Approved By =1--------- -"— datf Application Disapproved for the following reasons:— — - —------ --------——— — - —-- - ------ -- ---— --__----_- date Permit No.— N) G -- Issued---�� z -��--- ---- --- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ram Altered ( ), or Repairedby azz-0 ( ' ) Installer at- --- —- — -------- -- ------------------- --- ---- -- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.1--) uqV_U fDated �-t�'-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------- -- Inspector-- - —-----------------------—— ---—---- �aray� No.— Fee---- -= - ------ BOARD OF HEALTH TOWN OF BARNSTABLE A.ppricat ion-*rVell Congtruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: e Location Address - Assessors Map and Parcel j -- -- ------------------- —— — Owner Address --- -------- ---- ------------------—------------------------------------------------- , `r Installer — Driller Address Type of Building Dwelling ------- Other - Type of Building---- -------- No. of Persons---------------- ----- r Type of Well------------- — Capacity-------------——--------- Purpose of Well Agreement: The undersigned agreesito install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance,has been issued by the Board of Health. Signed /tea ----— — --= —date . _ --------— 1�- -- Application Approved By �— Cz I� Application Disapproved for the following reasons: -----= --------- - -----, - f-, ' . date Permit No. 2 GU L/ -V 6 Issued-- -ZT- ------ date — — BOARD OF HEALTH TOWN OF BARNSTABLE. Certificate Of COMPliance y THIS IS TO CERTIFY, That the Individual Well Constructed ( vp Altered ( ), or Repaired ( ) Installer at- --_— — — -------- -- ------- ---------- -- --- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.W I60 L_U WDatedTHE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE= ---- —------ - —— Inspector-- - —--------------------------—----—-—-- BOARD OF HEALTH TOWN OF BARNSTABLE Ve[[ Cootruct ion Permit No. --wa. d q-0 % Fee ------------- Permission is hereby granted' s., „�� / /"/-�'=----- — rJ to Construct (v`) Alter ( ), or Repair ( an Individual Well at: —iza. - - - - -- - - Street as shown on the application for a Well Construction Permit No. Dat 0_ -� tr - -------------------- _..-.. V Board of Health DATE— / • 2 7 " o L/ — BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering .January 16 , 1987 Board of Health Town of Barnstable P .O. Box 534 Hyannis, MA 02601 RE: Septic System Sentry Bank W. Main/RT 28 Centerville 85129 Gentlemen: This letter shall certify that the septic system has been installed in strict conformance with the design . A design addition of a paved sluce was -not represented on the original plan, however , the sluce meets all state and town standards . I trust that this meets your present needs . Very truly yours , Peter Sullivan, P . E . Baxter & Nye, Inc. P S/f m j y��P oF'^�Y' cc: Sentry Bank PETERC> SULLIVAN '�.. No. 29733 do0- �clstrsR�OO�� FSStON L MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS l AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS I TOWN OF BARNSTABLE LOCATION �Plt�}'tU ink ( favr r t?fi z�-Vi,tYbot�S"EWAGE # 5;6o t2A VILLAGE rercr,yy&,e., ASSESSOR'S MAP & LOT 2?-q -`nn- INSTALLER'S NAME & PHONE NO. Wu11P. S1�r+vt Ito- g95 SEPTIC TANK CAPACITY �f)OL) LEACHING FACILITY:(type) LP6flr\ Pt� (size) tp'yc NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER) BUILDER OR OWNER OW0 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Una o 730-�-7 \ 10' '$off F No..g�-- I g p ..................... -•�. \ THE COMMONWEALTH OF,MASSACHUSETTS ' BOARD OF HEALTH ................... ........................................... Appliration for Biipniitt1 Workg Tnnitrnrtinn jJamit Application is hereby made for a Permit to`Construct (`() or Repair ( ) an Individual Sewage Disposal System at: ....1_l �.... .. ........................ ----........ - ......................................................... Location--Address > or Lot No. .....�, �1•i�St�!. ............................................................... .... 5�__!�!4 .QC�.. .. 1_E_ - ' --- ownerr 2 Address e a 3C......1J7 �J. ..�t. 4 _. v�� :'!� J.....-- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `p4 Other—Type of Building Off 1 5?P._.......... No. of persons............................ Showers (c+lt ) — Cafeteria W J) a' Other fixtures --------------------------------- - w Design Flow.._..1_'.4Z!!-./1/.a...............gallons per person per day. Total daily flow............ .....................gallons. WSeptic Tank—Liquid capacity.` C.0.._---gallons Length................ Width---------------- Diameter_--_____-_---_- Depth................ x Disposal Trench—No..................... Width...............'.... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No.... N�_........ Diameter.,_ !.p__.__..... Depth below inlet._._.(;�r........... Total leaching area...4.18......sq. ft. Z Other Distribution box (X) `Dosing tank ( ) PercolationTest Results , Performed by...................................................I--------------•---_... Date........................................ ,a Test Pit No. 1..;.7�...._..minutes�per inch Depth of Test Pit------1_3r_........ Depth to ground water.._�� ;itAPA _. Test Pit No. 2_ .......minutes per inch Depth of Test Pit......A.1...-.._ Depth to ground water.__Ajo ------------------------------------------ ----------------------------•--•--.............................................................................. O Description of Soil.....B -�A r,.'?... _: i. _Z'_L_..r.....--1°�----7V_.._.....5./A.4:-;::>........................................................................ x w U Nature of Repairs or Alterations—Answer when applicable.__............................................................................................. Z Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary i2ode tunrsigned further agrees not to place the system in operation until a Certificate of Compliance h s bee issued of health. Signed...... •---------------------------------- -------------------- •---•-•.� a Application Approved By--------•--•------ . ----!�....................................... 01... .. ........ Date Application Disapproved for the following reasons'. ............................................................................................................_ ....................................................•--------...---------------------.. ...-----------------------------------•---------...----•----------------------------------------------•--•---- Date PermitNo.... .---•--------- -----------------•---. Issued....................................................... f` Date io..--•...... _....... Fins.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................. ........................O F....................---........._I...... Appliratiun for Biipustti Workii Tonstrurtiun rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................--......_...................................................................... --•-----••......_...--•----•---••.......••-•---••-----•---••-••---•-...•--•._......__............. Location-Address or Lot No. ......................--.......................................................................... -•---••-----•----•----........-----.....................--•------•••----•-•-•_.........._.......-- Owner Address w Installer Address UType of Building Size Lot....:.......................Sq. feet �.. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons............................ Showers YP g ---------------•--••-------- P ( ) — Cafeteria ( ) Otherfixtures .-------•----------------------------------•-•--------••----------•--------------------- w Design Flow............................................gallons per person per day. Total daily flow..............................._....._......gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----------- -------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 .•-----•--•-••-----------------••---------------.....------......----•--••------•...........-•••----••--.....--•••-•--••---------......._._.....-•---._.... 0 Description of Soil....................................................................................................................................................................---- x c, ----•---•••••-•-•••--------•-----------------------------------------------------------------------------------------•.............---•------•--•--•----------......---......------•....---•----...---- 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 TITLZ 5 of the State Sanitary Code The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..........----- ........................ --• ...............•. D t Application Approved By............................................ . - .........A. i- ....... Dat Application Disapproved for the following reasons . ------•--------------------------------------------•-•-----•-----•-•-•----------.........---•--......_-_..._ ------------------------------------------------------------•--------------I'll----------"-------------------- Date PermitNo..............•------------------•----•-.....-----••---- Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Trrtif iratr lif fEuntp ittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by-------------------------------•---••-•-------------------------..-----.thc •---•-•-•••-•-=------....____•--••--••-•-......-•-..._.......----••--•_...: has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Co a described in the application for Disposal Works Construction Permit No------ �' _?................. dated.....`— `f . � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. Y DATE.............................. ..................... Inspector------•--•--••---.............----•----------•------------------..........---•-•-- THE COMMONWEALTH OF MASSACHUSETTSIVC�)i7t@?^ BOARD OF HEALTH (`}04'v %NC``J's'C"I 2 d►�. ...................... . � No........................ FE .. .............. Disposal nrkii Tunu#rudiun 'prrmit Permission is hereby granted............... 1.1).11E-..... w--------------•-••--------•--•-----•--•--.............................................. to Construct (Y) or Repair ( ) an Individual Sewage Disposal System at No.................. L� ?_`"= ------..---!y:`4-'�'-----• }-lfhQ !�----.R`-'------ ................................................. Street as shown on the application for Disposal Works Construction Permit No...36-1 ated.._._. �. .: ............. ................................. At> ......... _ =. -•-••• oard of Health A DATE................. �0- .f. .. __.....__..... FORM 1255 A. M. SU KIN, INC., BOSTON.. �j A 't,OCATION SEWAGE PERMIT* NO. It LAG '.j INSTA LLER'S NAME & ADDRESS A. OR tlrN ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ., ..� r - t C-1 1 U TOWN OF BARNSTABLE LOCATION I �� ""O ^ R� SEWAGE # VILLAGE _ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No LS 9 V -:�Z n,4 T—,w- Y� svo ate.we y . �g�'��' � � � � ,b ��+; T�, � _ �� y No................ FEB.... ............ THE COMMONWEALTH OF MASSACHUSETTS 0 BOARD H I-V7?....OF.......... .......... T e ----------------- Appliratiou for Uh4poiial Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct (/) or Repair an Individual Sewage Disposal System a,: .....a�: .V ....................................................."--------------------------------"...... Location-Address or Lot No. ............ .................................................................................................. Owner O Address ...................................................... ........... --------------- -------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...........................................Expansion Attic Garbage Grinder Other—Type of Building ---1.5A�04-d ..... No. of persons.......................---- Showers Cafeteria Other fixtures ------- -------------------------------------------------------------------------------------------------------------*------*"**.........Design Flow ---gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tankt-Liquid capacity-/DQO..gallons Length________________ Width____,___________ Diameter______.__..._.__ Depth__.___.____..... Disposal Trench—No_ -------------------- Width_______._.._______._ Total Length_.__.____._._____.__ Total leaching area____._._________..._SQ. ft. Seepage Pit No------I-------------- Diameten-P------------ Depth below inlet..&............. Total leaching area.....:a�ysq. ft. Z Other Distribution box Dosing tank Percolation Test Results Per-formed by-----711ta ��%•---------------- Date------3:712-5(--)......... Test Pit No. ----minutes per inch Depth of Test Pit----J.C;........ Depth to ground water________________________ fi Test Pit No. 2_Z..Z_.minutes per inch Depth of Test Pit---- .. Depth to ground water________________________ P4 ----- ...... _q. ............................ ................. ............. 0 Description of Soil...... -ZN a f a -------CJ�&�4 .........(31QR.TR_. ............................ ------ --- 1Z------- 6�) Jyq-A)t,)L.........71 ....... AUS --------7=-7-ya. ....rl_ --------------------------- -------------------------------............................................................................................................................................ Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ........................ .............................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syst in accordance with the provisions L TITLE, 5 of the State Sanitary Code— The unde * ned further agre s not to place the system in Syst s not to 0 operation until a Certificate of Compliance has Peeuissued by the b r e I Si �36;dq. . .. ... .. ....... .. ... .. ...... . ........................0 ate ,,CApplication/Approved By........ .... . ............ 7_7_ .... . ......... D a-t-e Application Disapproved for the following reasons:.......... --- --- ................... ....................... ....................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .... ..........,A�... ................................... UpWrtifiratr of Toutpliatta THIS IS •40 (CE;6,FY, That the Individual Sewage Disposal System constructed ( Repaired by..:�=.........?-, ... . .......W............ ------------------In: ----3f------------------ ---------- . ........................ ...... ... --------------------- has been instilled in accordance with the provisions of 'Loa 5 of The State Sanitary Code a�sd�e J, ed in the di ----------------- .... ... ....F application for Disposal Works Construction Permit No IL-3. I NSTRUEDted------THE ISSUANCE OF THIS CERTIFICATE SHALL..N0-__-T._ _B-i CI AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.-.-.PA.11.- .-..P................................... Inspwtor... ------4-1_qjd,�_ (-------------------------------------- CAAE a Cq I"' NO..........7•`.1 - .. ........................ THE COMMONWEALTH OF MASSACHUSETTS t BOARD Qf H�E4U7ff '. .....O F......... . ... .................... Appliration for UhipmW Worke Tonatrurtioit 11amit t�pplica6on is hereby made for'"a Permit to Construct (+!,) or Repair ( ) an Individual Sewage Disposal :S stem at .a. �...... .....r --..S..:i... ._ !........................................ .............._......-......._ .......---_.......--.......--..............................-_. LocaU=-Address # or Lot No. Y W ,y canerAa�r Address .......... -1° ... ................ --------•---•---•---•.........................•--------...----------•-•-- Ifs alley fl Address d Type of Building Size Lot............................Sq. feet Dwelling:Y-No. of.-Bedrooms ..........................ExpansionwAttic ( ) Garbage Grinder ( ) p, Other—Type of Building _-__.__/s.1.3--tp---. No. of persons _________________________ Showers ( ) — Cafeteria ( ) dOther fixtures _ ______________ w Design Flow.... .. t i -_-gallons per person'°per day. TotW daily flow '" �......... ......'_. ......gallons. WSeptic Tank I--Liquid capacityAP?Q-,_gallons Length.................. Width................ Diameter................ Depth.. ................. x Disposal Trench—No. .................... WI .. Total Length.................... Total leachngiarea-----_ ._..__ sq. ft. Seepage Pit No.................... Diameter :'Depth�b w inlet................ Total leaching area._ � q. z Other DistriI3'ttion box ( � ) Dosing_tank a Percolation Test Results Performed by .... ................... Date_ S Test Pit No �` "�. rnmutes per inch Depth of 1Test Pit f .. Depth to ;n nd water r sue_ ` r,n ,t ( ?" "� �..t , i ]si -.. Test Pit iV o . `_.i....nunures per inch Depth of. est Pit Y__ ►�_ __. Depth.to ground walerg .___. ............ 3 A t t Ct C [y 5 *41 t D Description of Soil "/ Y�+tT A. •- ... --�_..-. -•----� ....... G �,+ ? ` -- 1J I. w U Nature of Repairs o: Alterations—Answer when.applicable................................................................................................ y . --------•-----------------•----•---••-•-•-•---•------------------- ----------------------------------------------------------------------------------------------------•-------- Agreement: The undersigned-agrees .to install the afprhedescribed Individual Sewage, DisposapSyste `in accordance with the provisions of TITLE 5 of the State San>tary Code— The>inde ne further agreplace the system in operation until a Certificate of Compliance has ssued by the bo r f ea✓•Si - = ate Application Approved By••-- -• f #,.W•-•-•------ � Date Application Disapproved for the following reasons:---•-----•-------•-•---- -----••--•-----•------•------•---•---•------------------------------------------------ ............. .................................................................................--------•..................•-----••. -----•......--•----7----------------------------------- Date PermitNo........................................................... Issued•....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O,F7 HEALTH rf .f............OF.... ...... n............................................. (9rdif iratr of Tort pliattre THIS IS tO CE FY, That the Individual Sewage Disposal: System constructed epaired ( ) by... ......................... r. �'yy �f f-- at---`�k ,__._ has been installed in accordance with the provisions`of T r of The State Sanitary C�_de s de• r' ed in the application for Disposal Works Construction Permit No___ ........ ............. da.ted_-.. _." "` _._..._.____._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEK WILL FUNCTION SATISFACTORY, DATE. •----------••--•- Inspector.............................. ........................................................ 'v. THE COMMONWEALTH OF MASSACHUSETTS .« BOARD HEALTH ..........O F....... �� ........ .................................. FEE.. 1; Disposaljue Tongtr w, u amit R 5 T Permission s nereb granted............ ....••--- ---••------••••. •....-- .......................... ......... Ll'� FqRm o Constru ( or it an wag is p S ». at No. Sty �+ s shown on the application for Disposal Works Construction Per it o. _. _. ted.... _ � ..................... ` ---- - ------- ---------------•-- A /� y Board of-Heal 4+ DATE { -... .. J ----------------•-------. ...... � 1255 HOBB� & WARREN. INC., PUBLISHERS ' - ' x. �. , , y,M , ; J ; .,, I >~ .„ , . 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