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Home My WebLink About0053 HAWSER BEND - Health 53 HAWSER BEND, CENTERVILLE A=192-087 i I IN Ntui 2C 67534 COR WW HASTINGS,UN r 7 �,1 f - 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information I q9t 9, Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);I have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8-31-20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form I� ws i.'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: System is in good working order with no sign of failure. 2) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) 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. ❑ Y ❑N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r `L, Commonwealth of Massachusetts a Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ON ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ON ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form �.I ail Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �=- >°` 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y/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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .!r► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2020 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 � ° : Commonwealth of Massachusetts c� Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments FV fr 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner----pumped 2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Hi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r r 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a T, 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts 1� Title 5 Official Inspection Form r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee, or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc): 8. 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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form i� wa i6,l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. 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.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form ? it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-2'x30' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �i Title 5 Official Inspection Form w:+ i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach trenches in good working order with no sign of back-up into d-box or surrounding stone. 12. 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �.1 3, Title 5 Official Inspection Form C�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts 1� Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is Centerville MA 02632 8-31-20 required for every page_ City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately fd - ram mar e OtU "' f ed� o�A" b 3 �e 3 w b r a 2 3~ Y-,? �3' ? � 3G 71'4 � t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ! N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f U :..o >` 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is required for every Centerville MA 02632 8-31-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 124 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 s Commonwealth of Massachusetts w; Title 5 Official Inspection Form hl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments %i � :. 53 Hawser Bend Property Address Katherine Parcels Owner Owner's Name information is Centerville MA 02632 8-31-20 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 1T�f.1.ACFa �P t�-�'�!t>�� • 1��OR',I i�P�I�CYf� .: Ix Ma pin NOo oF3 B Off£6VNML iAdITINAMTea G4CEl � '$�twe&�s t3tc. -. • bdax�minm�AdJus C d eiQtheBottombf 4 A.M.tg�at�ity Fie�fCacarpU+�li au�ctng$may ��" : , Bye of�let#�itst mud Leacitmg. litY��Y wsttaiids exisi �t 9tifl�EOet�€�es�Mt�faces i,� � �' t ? e-c> 10 Wert no 14�- n / �} �! - i86 `• d- � - 3ob � Ara - P�"f" .3_ Yy' A ,ci- ic/ 1 -�- plc 4 A-( - 3, No. 0 Fee [/'— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4pliCatlon for Bisposal *pstrm Construction Vrrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5 3 w�� / Owner's Name,Address,and Tel.No. 7/' Assessor'sMap/Parcel L�r)*/t�✓,��p ka /Pr.tie A f/'c��3 Installer's Name,Address,and Tel.No. �V$ a gy —y 74.7 Designer's Name,Address,and Tel.No. T,f X.Q //9 G o.�,gTrric'1 a� f /� Type of Building: Dwelling No.of Bedrooms g4— 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) Sewer //'tie rP I-eV -60 wr hose Z2 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 o lth. Signed Date Application Approved by Date C T Application Disapproved by Date for the following reasons Permit No. C?C9 t ro Date Issued _ e No. Fee l THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for•BispoBal Opstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. 573 Owner's Name,Address,and Tel.No. Assessor'sMap/Pazcel `/a;2 7 l�h��r✓'�/� kiifh�rf+e 197f- Installer's Name Address,and Tel No. a 9y 7 7a Designer's Name Address,and Tel.No. h f to Type of Building: Dwelling No.of Bedrooms 4-- 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) Srwev- vie v/�� /+ / -C Yo v» �vtP 7 Date last inspected: _.✓ j 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 lth. Signed Date — r Application Approved by r Date Application Disapproved by Date for the following reasons I Permit No. o(j R rp Date Issued ` f THE COMMONWEALTH OF MASSACHUSETTS u red SP / BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) Abandoned( )by �,fl G�✓�5 at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No_.201- U)& dated 2 Installer Designer #bedrooms Approved design flow gpd The issuance of is permit shall not be construed as a guarantee that the system ill c i/on as desi ed. Date a. l u t Inspector / i. j0 d -------- No. )o� ` bf,6 Fee (� THE COMMONWEALTH OF MASSACHUSETTS- PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction i3ermit ' Permission is hereby granted to Construct( ) Repair(t/j Upgrade( ) Abandon( ) System located at �3 ✓per �„�,,u>/ ,�, �,,,'�/� i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided:Construction must be completed within three years of the date of this permit.�^ jDate —p C Approved by TOWN OF BARNSTABLEjC/ LOCATION'63 SEWAGE # 1-7 9.7 `4 VILLAGE Cxhr-vr y l//_ ASSESSOR'S MAP'& LOT- 2 0'?'7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /000 LEACHING FACMITY: (type) I- 30` T 6HcG's (size) 3 0 ` NO. OF BEDROOMS 3 BUILDER OR OWNER ('X rXi�1 �t¢l Gl tyi PERMITDATE: 4—2-47 COMPLIANCE DATE: Q 3, !F7 Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 vm&, ' t .r F !G ;moo N 77a. - 6 97 No. �eZ ,r � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpfication for �Digool *pztem Construction Perron Application for a Permit to Construct(r-J'1Fepair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S 3 e�"S' pa" Owner's Name,Add'dress /and Tel.No. Assessor'sMap/Pazcel 64rh Installer's Name,,&_AAddress,and Tel.No. Y%�7—03�9 Designer's Name,Address and Tel.No. ,Avepl, &'p V S gi � .l Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq!ft. Garbage Grinder( ) Other Type of Building No.of Persons /� Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculat�ed 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) z Xis T/�i a/ h= i 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 issued by this oard Heal h. Signed Date 9 -2- Q7 Application Approved by - Date - - Application Disapproved for the llowin reasons Permit No. Date Issued Ufa a No. ; �. ,.� Fee 1' ; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer s ' PUBLIC HEALTH DIVISION - TOWN OF'BARNSTABLE., MASSACHUSETTS Z(pprication for Migaar 6peom -Construction Permit Application for a Permit to Construct(4-Repair( )Upgrade( )Abandon El Complete System ❑Individual Components Location Address or Lot No. s"e /sh Owner's Name,Address ' d Tel.No. 1/$—l ds-9 Assessor's Map/Parcel * Installer's Name,Address,and Tel.No. y9'1-03�+/9 Designer's Name,Address and Tel.No. Jafcpti 01 Qlarrp S Type of Building: Dwelling No.of Bedrooms 3 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. "JJ Description of Soil .Sfo h .1 Nature of Repairs or Alterations(Answer when applicable) // 9AIS 6i L 4&,.rli C'/ao l .5,NAZI X" 011 a- �,0 &_,Ne,„he. rrlw64 .Ta x y x 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 issued by this Board 4Hea h. Signed Date Application Approved by Date Application Disapproved for the ollowin reasons J Permit No. ,7 Date Issued ----------------------------------- THE COMMONWEALTH OF MASSACHUSETTS .BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance f: THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( 4-}"'Repaired( )Upgraded( ) Abandoned( )by Jos,_,,P D.4 agr,�os at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer OJV D.4 b1lo'.vd s Designer oSxpti Ve The issuance of this permit.shall not bep pstrued as a guarantee that the system will unction as designed. Date - Inspector �\ ———————^———————————————————————————————— No. - tl 72 19, _ 677 Fee I �""i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 0i5pozat bpztem Con0truction Permit Permission is hereby granted to Construct( 4--rRepair( )U grade( )Abandon( ) System located at ,'3 #ilklS ch Qth ' Cr,,yreeVf 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 permit. Date: / � Date: "a " / -7 Approved by NOTICE, 'ChI Curn1 is to be trMed Cue the repair of thiled meptie s sterns only y UAKU LC CILUI�L�� SI B Ct_ A1V p '�LLCAIM1 VRA- "S," we�l��rc�lys�t,�r�leiy r . Miff��1i__ t�ci r��sic�Hr� r�Ai� I, t/os—g O?�- 6 ivies , lleteby telilry that the rapplictitlon rot disposal vvotks construction permit sighed by me dated q-- 2 -97 , coiicething the property located at S"I H-o�✓s�� [�.�;�� _ _ Meets till of the following criteria: 6l- Mere are no wetlnnds withili 100 feet of the htopoW 9eptlb 4ysletn 7laere are ho private cells within'I10 reel of the ptopw4ed septic aystew X"Ibe observed ground*nlet table is 14 feet tit gteatbt below the bottom of the leaching facility ' 1, here is no increase in flow find/or thong@ In tlse ptoposed �iere are no vnriance9 tectuested of needed. SIGNED9 -�2---- LiCliNsrt)srpi-lc SVs-rl M iNs't'ALLPR IN 411WI-OWN or. MRNs1At3Lp NUMnot _ [Attach a sketch plan of the proposed gystetti.Alm If the licensed Installer posesses a certified plot plan, this plan should be submitted]. q:hcnllh roldrr:coif _ a Pr� 6xi�r�hy r000 G�� sr O 3 ��Gh P. TOWN OF BARNSTABLE LOCATION t3 N�s�vse,-- r;G,r°f SEWAGE #:. . VII.LAGE ASSESSOR'S MAP & LOT /92 027 INSTALLER'S NAME&PHONE NO. or•ep� SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) 1- 3U Tr 6 'S (size) NO.OF BEDROOMS .3 BUILDER OR OWNER PERMITDATE: 4—2-97 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 facpy) Feet Furnished by �T IWO . d _ Irc ark o�4p�7D 7� • 1 �.7 _ - L.00',T10N SEWS►C,E PERMIT k10. WSTQLLER 5 U&NAE ADDRESS bUI1,PEP S Q &ME ADDRESS DIaTE PERtAIT ISSUED • f 7 — — — D ATE COMPLI &KiCE ISSUED ; - - - i'A 1 : 730 I `s No.....J� .y..�.. Fim ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ . .. .................OF...................................................... ................. ...-....... Appliratiun -lux Uiapuual Works Tomitrnrtiun Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: LoT •• << ..r j (J�GG C= C -T......v/Gc -•-------•- ----- --� - -•--------------------------•--------•--- r`h Location-Addr*sfs or Lot No. e .............•-•----- Dl-- Safi �If9 .111.��.�...... ................. . -.....•-- .--.... h Owner Address Installer _ r Address Q Type of Building Size Lot__________ _______________Sq. feet h, U Dwelling—No. of Bedrooms.......... .___.Expansion Attic ( ) Garbage Grinder (P;-67 pa, Other—Type of Building '............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) A' Other fixtures W Design Flow------ ..._... gallons per person per day. Total daily flow....._.....yU a____________________gallons. WSeptic Tank—Liquid capacitygallons Length................ Width................ Diameter....... -------- Depth---------------- x Disposal Trench—No. .................... Width.................... Total Length_--______-__.._-_-_ Total leaching area--------------------sq. ft. Seepage Pit No......'I---------- Diameter-------1__X7 Depth below inlet____________________ Total leaching area.__.y o-a--_sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........._.--.-_.-..---. fzq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--._--__--_--__--.... fZ •-----...--•------------------------------------•--•---------•------...----------------•--•---•-•--•......................................................... 0 Description of Soil....................................................................................................................................... ----------- -------•------------ x ------------------------- -------------------------- ------------------- ---------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------. -•-------------------------------•------------- .-------------•---------------------------------•------------------------------•---------•----------------------.-•-•--•------------.------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�theoard�.....h Signed..... ! . -- ------- ----- ---------10 --------- Date Application Approved By----. ° 1�_._>--------------------------------------------------•-----------•--•-------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------••---•--•-••---••- --.......•--------------•--------..•.---------....------------------------•---------•••-••---•-••---•-•-•-••--••-•---------•----.........._....----•-------......----------------------•-------------••. Date----••• Permit No------------------ Issued.. `-rZ,�. Date ---------------------- - - - — - No....... ........ ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ............OF..................................... ............................................----- Applirntion -fur M.poiial Workii Tutuarnrtinn Vrruiit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... ------------ -•-•-•--• -------------- -•-------•-•-----•---••-------•-----•---•-------...------...-----•----•-..---•- ••---•--•----•-- !�1/ZG Location-Address or Lot No. T..l...r...Sc................................ ................................ i.i Owner j Address Installer Address UType of Building S Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms-___-___-_�`________________________________Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures -----!%_------------------------------------------- W Design blow______________________________ f.__.-gallons per person per day. Total daily flow............ ..........__....._....gallons. W Septic Tank—Liquid capacitye-�G�/gallons Length-__-__-_•_.-_-_- Width..__.---------- Diameter________________ Depth---------------- xDisposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No.._...�..-------- Diameter......... .... .:.. Depth below inlet.................... Total leaching area-___: ---sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by----------- .............................................................. Date......................... ------------.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water........................ 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit_-__-_.___...__-____ Depth to ground water__._--.______...___----. a •------------------_-- ---------------------------------------------------------------•-----------......................................................... 0 Description of Soil----------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ x ! M U Nature of Repairs or Alterations—Answer when applicable.................._----------------------------------------------------------------------------- ----------------- .....................-------------------------------------------------------•-------------•------------------------------•--•----- -•---------------•------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-----�/ -� _2_Ztl'...� Date Application Approved By...... 1� Date Application Disapproved for'the following reasons:-------•-----•-•---------------------•-•-------._.........---------------•----....._•-----.....-----......------ --........--•.................................................•------------•--------•-------...---------------------------••----•-••------------.._._..--.----------------------_-----------------_----- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :..... .......... oF.......... 7. r............................ ................................... 1rrtifirntr of Tilutphatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by............... 4' -------- .................................................... ------------•-------- ------------- ...... -----------------------------------------• Installer at. 1 n 3 r I. .�i jr -`i . . . r -tall has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... _________________________ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--- V= ' ------------------------------------- Inspector--- .a f"L------•---------------------•-----------•----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �- l ................T... ....!:.............OF...�i ,c•:...'. 12 i. -.........----------------------- �-�— FEE__�f.....!.:...._.. �i5$��t£MI Drk,� �d3n5trnrti�Bt �Crnttt Permission is hereby granted----_----------- ______________�_..... ------- to Construct (K ) or Repair ( ) an Individual Sewage Disposal System at No..........4-----r ---' ' —.. ............. Street as shown on the application for Disposal Works Construction Permit No.... ------ Dated------ .... --•--•--•--------------------------------------------•----------••---••-----••------......---•-•-•--•-•-- Board of Health DATE--------------------------------------------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA k a F S i 9 q � i t e i r a , 3 .i