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Home My WebLink About0236 NOTTINGHAM DRIVE - Health 236 Nottingham Drive Centerville A= 171 —036 No.4210113 ORA Pond,nov f & 10 0 ti7 ® ® 0 0 1 ul LL i lu;4up Commonwealth of Massachusetts Title 5 Official Inspection Form 'A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stem Owner Owner's Name information is required for every Centerville , MA 02632 7-18-14 page. City/Town Stale Zip Code Date of Inspection Inspection results mast be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out fours A. General Information on the computer, `��.��H OFMA��i�0 use nly the tabmove your 1. I nspector: l`� 22 a23� 9s9 key o cl•�� cursor- do not James O.Sears �:• JAMES R,= use the return ^^ key. Name of Inspector ? *: *= CapewideEnterprisesLLC � �,•.,�, o :Q r� Company Name — 153 Commercial Street O��i��F rgr I Ir SP'cG`\`�`�• Company Address nrrr�n _ Mashpee MA 02649 Cdyfrown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CHAR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-22-14 4tispectoes 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. **'*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. Lo d 3b � Gino•3f13 I Tuie 5 WOW on Form:Sutsurfaca Sewage Disposal System•PeQe 1 of 17 ,JUI LL 14 1U:41p P. Commonwealth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-1&14 page. Cltylrcm State Zip Code Date of Inspection B. Cerdfication (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: [] I have not found any information which indicates that any of the failure criteria described in 310 CMR 16.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system cdmponents 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 pass. ass. P 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): 15irts•3r?3 Title 5 Official Irtspecton Form:Subslxface Selvage Disposal System•Page 2 cf 17 JUI LL -14-I U:4-1 p N•� Commonwealth of Massachusetts Masom Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner information is Owners Name ' required for every Centerville MA 02632 7-18-14 page. Cityrrown State Zip Code Dale of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally.Passes(cont.): ® Observation of sewage backup or 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 ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): Need to replace line tank to pit 4 1. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ .N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 Hb)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 t5ins•3113 Title 5 OffeW Inspection Fomc Subsurface Sewage Disposal System•Page 3 of 17 ,Jul LL -14-1U:4 1 p P. Commonwealth of Massachusetts _ Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Ownees Name information Is required for every Centerville MA 02632 7-18-14 page. Citylrown State Zip Code Date of Inspection B. Certification (cost.) 2. System will fall 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool /Lj,q ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than '/day flow 7/7' 15IM-3/13 -- Tills 5 0111IGal Inspection Forth:Subsurface Sewage Disposal System.Page 4 of 17 Jul Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. City'rrown State Zip Code Date of Inspection B. Certification (cant.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10.DOOg pd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or'no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the.system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department t5ins•3113, Tile 5 Olricia Ins P8ClI0r1 Form.$ubSUfIace$aWBDe Disposal System.Page 5 of 17 Jul LL 14 l U:4Lp N.o Commonwealth of Massachusetts Title 5 Official Ins ection Form p Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following.- Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information.on the proper maintenance of subsurface sewage disposal systems? The sae and location of the Soil Absorption System (SAS)on the site has Y ( ) 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) [WO CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 ISIns•3/13 Title 5 Officivi Inspection Form:Subsurface Sewage Disposal System•page 6 of 17 Jul LL 1-+ I V.'+/-p N,r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. Cityfrown Slate Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank and two pits Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2012-58,000Gais Detail: 2013-39,00OGal's - Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commerciatlindustrial.Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc,): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•U13 Title 5 Official Inspection Forms suosurraw sewage Dispoed Syslam-Page 7 d 17 Jul LL 14 -1 U:4:Sp P,o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owners Name requiredfo e every Centerville required for eve MA 02632 7-18-14 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? Q Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping_ Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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): t5v s 31?3 Title 5 Official Inspection Form:Subsurface Se%age Disposal system•Page 8 of 17 Jul ZZ 14 1U:40p p.a Commonwealth of Massachusetts Title 5 Official Inspection Form E _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address — Claire Stem Owner Owner's Name information is Centerville required for every MA 02632 7-18-14 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: Tank and pit # 1, 1980 permit #80-173 / Pit#2 1988 permit# 88 0364 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on.site plan): Depth below grade: 32" 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.): Pipeing is SCH -20 PVC. Pit#1 to Pit#2 Pipeing is orange burge-tank to pit# 1. Orange bur e lace line line is bad need to r g e . Septic Tank(locate on site plan): Depth below grade: 2' 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.Precast H-10 Sludge depth: 15ins•W13 TMIe 5 Official Inspection Form:Stbsurtace Sewage Disposal Syrem•Page 9 of 17 JUI LL l4 1V:43p N. Iv Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Properly Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. City-r own State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" -- Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level. Tank and covers at 2' below grade. In and out let baffles. No sign of leakage or over loading. 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 t5ins•Y13 Title 5 Official Irspe tim Form Suasufaao Sa 96 Olopvool Cyatam•Page 10 or 17 JUI LL 14 IU.44p Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stem Owner Owner's Fume information is required for every Centerville MA 02632 7-18-14 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Capacity: gallons Design Flow gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): `Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15In,•3112 Tittle 5 Officid InspooYon.Forrm Suboarlece Sawaya Diaposd Gptem Page 11 of 17 Jul LL 14 1 V44p P. I G Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. City/town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): 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. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5im•W13 THIe 5 ORcial In3peC110a FCM Subsurface Sewage Dlaposal System•Page 12 o/17 IJUICL 14 1U:44p P.IJ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page- City/Town State Zip Code Dale of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: 11 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.): Leaching is two pit's. Pit #1, 1980/ Pit#2, 1988. Pit# 1) At 3'below grade w/cover at 20"dry.Out let tee to pit#2. Pit#2)At 44" below grade w/cover at 17". Pit#2 dry wlstain line at 18".No sign of over loading or solid carry over. No high stain line 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 t5ins•3113 Title 5 Official Inspection Form:Subsurlaoe Sinvage Disposal System•Page 13 of 17 Jul 22 14 1 U:4bp P.-14 Commonwealth of Massachusetts Title 5 Official Inspection Form \Vj Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner owner's flame information is Centerville MA 02632 7-18-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3M3 Tile 5 Ofr+ciat Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Jul LL 1'+ 1 V.'+UP y• Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stern Owner Owners Name information is required for every Centerville MA 02632 7-18-14 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �c£ �R C Ad2 =.33116 13-3 5 �° , O o (f-3 - "� a ^ doer 3 o fi Ir 13- Y= 38 -V °i-.' oe 151ns'3r13 Title 5 official Inspection Form:Subsurface Sewage olsposal System•Page 15 of 17 Jul LL 14 1 V:40p P. I u Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 236 Nottingham Drive Property Address Claire Stem Owner Owner's Name information is required for every Centerville MA 02632 7-18-14 page. Citylrown Stale Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells D Estimated depth t high ground water: 13' 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: Hand Auger T.H.13'no G_W.. Bottom of pit#2 at 10' below grade. Bottom of pit#2 at 3'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3013 Tdle 5 Official hspection Forth.Subwdace Se%vaye Disposal System-Page 16 of 17 Jul LL 14 lu:41)p N. I r Commonwealth of Massachusetts �MOOR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 236 Nottingham Drive Property Address ' Claire Stern Owner Owner's Name information is Centerville required for every MA 02632 7-18-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information —Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5irs•.3113 Title 5 Official Inspection Form:Subsur!ace Sewage Disposal System•Page 17 of 17 t. TOWN OF BARN_ STABLE LOCATION�t _I�/�'(1 (1�l�ri �k' SEWAGE# p��`7 �y Cw a VILLAGE Ce ffi M i ASSESSOR'S MAP&PARCEL Q INSTALLER'S NAME&PHONE NO. P KM 5 CC'<:S$S-gq," SEPTIC TANK CAPACITY l ay !Aa'(Vn5 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS OWNER d{ I PERMIT DATE:_ -�i�-i-I� 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 !. T A— Z,Vq gv Z-Ke4g VQ.3AZ5'�, # ` l—' 7- 8-5s31`` A SP bg,, No. / ^t/_ ! 3 Fee CJ® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Miopooal bps tem Con9truction 3permit Application for a Permit to Construct( , )Repair X Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. .,t m ��l Owner's Name,Address and Tel.No. �o*i a No ire e CS�rrn Ass r'.s Map/P I � Install s Name,Ad ress,and Tel.No. De ' er's Name,Address and Tel.No. j �t.M elos ,cr►��'�!=� n�'' W;CIS?- 4EA4C fin" (. 81,3 H oK� /L 1c- i?e3--1- oeA✓� i S 1153 avwlr�+ �,a eel Type of Building: z. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(11%.4 Other Type of Building No.of Persons / Showers( ) Cafeteria( ) Other Fixtures Design Flow 3—2) gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 0 40 151 4.ffe,c'i Type of S.A.S. Description of Soil C4 Nature of Repairs or Alterations(Answer when applicable) di "i7 4)d1 lo C30L CII a '. .k'. Date last inspected: ' Agreement: The undersigned agrees to ens the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions le 5 f the En mental Colle and not to place the system in operation until a Certifi- cate of Compliance has been issu y o eal Signed I Date Application Approved by Date? Ll Application Disapproved for the following reasons Permit No. Ll 1 j Date Issued No. / ^� r Fee �Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f Z(p pfication for �Dio pogal *p5tem-Construction Permit - Application for a Permit to Construct(' )Repair X Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �3� 1 Qm f 1r�V Owneer's Name,Address and Tel.No. As ss is Map/Parcel 1� IJ "'a t re 'S p rn ��; �3e CeM4 L) 11,0 Installer's Name,Ad ss,and Tel.No. De ner's Name,Address and Tel.No. p jC,m C��, C--0r CaP&,Wi die. F�r�pn' 313 H O 3�1C- Oca— Q oZCpY S Comm a c,;a1 S` .�f —,--Type of Building: °. Dwelling No.of Bedrooms Lot Size sq.ft. �. Garbage Grinder Other Type of Building' No.of Persons / Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title r Size of Septic Tank /DOD 44 l�fi/1 Type of S.A.S. i Description of Soil r_G C r Nature of Repairs or Alterations(Answer when applicable) Ada (i i szd On k o 1L CA n -------------- nP-w o -e Iio 'n ae' ' -fln NPR0� ' Date last inspected: Agreement: A t f , The undersigned agrees to ensue�the construction and-maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Iftle 5 of the Environmental Code and not to,place the system in operation tintif-a Certifi- cate of Compliance has been issuegs , ,L''s�1�3 d o ealth. / Signed Date / Application Approved by Date- L� L Application Disapproved for the following reasons r Permit No. Q' Date Issued THE COMMONWEALTH OF MASSACHUSETTS , BARNSTABLE, MASSACHUSETTS '9 Certificate of �Corrt 'tiahc e THIS IS TO CERTIFY, that the On-site Sewage Disposal System to'nstrueted'•( )Repaired ( )Upgraded( ) Abandoned( )by n at G, G — Ce has been constructed in accordance with the provisions of 1 i e 5 and the for Disposal System Construction Pe Na b�� y 3 dated ��f/% Installer 016M �/t Designert -The issuance of this permit shall' ot/��,�o�i s ,eVs a guarantee that the system will unc ion s design Date ! ! J� Ji Inspector '---- ... . ------- No. 4D�LI '�J 73--------_------------- � Fee ., THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5pooal *p5tem Construction Permit Permission is herebyranted to Construct Upgrade( )Abandon g Repair( ) P (�)UPg (_ ) System located at VQ`" Q 016, r A 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 f Provided:Construction mus be co lete within three years of the date of this p mi . -^� Date: / ��j Approved b LOCATION SEWAGE PERMIT NO. u VILLAGE I N S T A LLER'S NAME i ADDRESS III UIL0ER OR OWN r DA T E PERMIT ISSUED DATE COMPLIANCE ISSUED t r _ i i� t i ��` �� 'i ., ' i � � � \ �` �, 3 !" x s�;a° ' �� a `�, \\�� ,�` No......80-./,7 Fres.. ...5.�_��.......... THE COMMONWEALTH OF MASSACHUSETTS f BOAR® OF HEALTH ..................._..Town..........OF............... arnstable__............ ... Applira#ion for Diipnoul Work.5 Tunitrurtion Fautit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .2.6-.Nottingham. Dr:, Centervilley MA 02632 .............•--••----....-......-----------._........---•----•---------...------............... Location-Address or Lot No. Ka�lar�-----•---.....-•---••--•----------------•---------------- 23.6..Nottingham-Dr:x..Centervi-11e t.:n....026_32 Owner Address a •A--&-•B Cerjspo91..S� !ion•••-•-•-•.............••-•----••-••••--•-•- 128_•Bishops_•Terrace....Hyannis�_.MA....02601-••-- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..................._•___-______.__._._______Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ____________________________ No. of persons......... _-___________-___ Showers ( ) — Cafeteria ( ) Q, Other fixtures -------------------------------- . d - ------------- •----------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow_.__.___..__.________..-_____._____.--_____.gallons. WSeptic Tank—Liquid capacity............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. I________________minutes per inch Depth of Test Pit.................... Depth to ground water__-____-__-___________-. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------------------•----....••-.....---•-----------._...........--•----•••••......................................................... -0 Description of Soil--------------S ...................................................•-•--••--------- --•--•-•-•-------••-•-••-••-•-••---•--•--•--••--•--•-•-•••...••-••-••••--. x W •-----------------------------------------------------------------------------------------------------------------------------------••••-•--------------- •- x _ installation of a 1,000 gallon pre-cast V Nature of Repairs o: Alterations—Answer hen applicable------------------------------------------------------------------------------ stone packed leach pit (overflow. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with ' f'1T:T�-1-^ the provisions of : 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_ _4115AI ............ le D to ApplicationApproved By.................................................................................................. . ...........4115 _ Q-•--•••••••- Date Application Disapproved for the following reasons:................................................................................................................ -•------------------------•-••---•---------------------------------------•---------.._...--•----------------•-•--••••--•••-•--------------------•------------------------------------------------------- Date Permit No...........89--...................................... Issued................... 11 180.................. Date No........ Fics.....�... . 44....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................_.....T own........O F.................Ra.rnsta ble---------------------------------------------- Alip iratiou for Dinpu,ial Works Tow5trurtiou ami# Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ...236 Nottingl?am, Dr. . Centerville,..MA- -02�32.......• •-•--•••••••-••-•-•-••-••..................... Location-Address or Lot No. ......................rnold ... Ka Alan -------------------•-------•-•--••-------.... 236..N_ot ��la ,.,l�r a ^ n .e l le; i fl.....62632 J----------------•--••-- Owner �ddress a .A-&•.. ......Ce papgg .. Q�:�t c�....................................•---• 1�2 .- i shop =I'm c , tan #s;...r 4..--�2rfv-1... Installer Address Q Type of Building Size Lot............................Sq. feet U g—. ..............Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms.................3...__..... aOther—Type of Building ............................ No. of persons..........2---------------- Showers ( ) — Cafeteria ( ) QI Other fixtures ------------------------------------------------------.- 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 ( lk4) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1............."'_.minutes per inch Depth of Test Pit.................... Depth to ground water-----------------_-____. 0 Test Pit No. 2............� r-..minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----------------------------------------•----•--•-------------....---•-•-------------------------------•--•----•--------...................------. O 1 Descriptionof Soil---------------- ---------------------------------..........----•------------:--------------------------------••-----•-------------...---•------........-•---_.. .I. W tri ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Re ai s r Al.erations—Answer when applicable._--_---nstalZation--Of------1-,000--ga ,Qn._ xe-Q�st v stone packed �eac. pit (overflow) . p ------------------- ...................... ------. --------------------------------------------------------•--------------•-----------------------------------------._...--------•--•---•............... Agreement: The undersigned .agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of .y 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 by the board of health. Signed.-ZZZ- -. t= ' 2., U=?• lyl �?p............ ate ApplicationApproved By.................................................................................................. . ...........4/ jr J- 0 ate Application Disapproved for the following reasons:.....................................................................................-------------------------- ••--------------------------- --------------------•---------------------•-----------........--------------------••------------------------------•----------..,---------------------------------•---•--- Date Permit;Ai 80 Issued..................--/,7.5/,99.....------•-------- Date„ THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH a.......................Town........OF...13rnStaUe....................................................... Trrufiratr of Tuntplitturr THIS`IS TO CERTIFY, That the Individual Sewage Disposal System constructed (. �) or Repaired (X) ' by A Fc . Cesspool Service, 128 Bishops-_Terrace,--Hy_ 11 ,...N`A.....02601.. -1r-.775-62.64............... - - _ Installer 236 1_ottinghaM Dr. , Centervgl � fA 262 "-.AjM91d J•--&Flyat_.... F _ l 3 .... -------- has been'installed in accordance with the provisions of TITLE j of ThO.State Sanitary Code as described in the application for Disposal Works.,,Cons uction Permit No._$0-____________________I............. dated----4/1 /80---___..._-.------.----_-- Ij THE ISSUANCE OF THW'CERTIFICATE SHALL NOT BE CONSTRUED A "A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............�.� �8...' ....... Inspector----=-.�-•----. -- ---- 1 THE CO''MMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................Town...........O F:..........&.=otable...................._......._............--... No. 80- FEE.$... :.JQ0......... 'Dispas tl rk � #r i ri rruti# A Permission is hereby granted.A dC B Cess�oo�,--Sxy�Gg-,---128-_$ sZ�op .T� �c��...1[yai.s7 1^�4•-•-�2601 to Construct ( ll r Re air ) an Individual Sewage Dispposal System A 6 Ndt�ingnam r., Centerville, NJA R692 -- Arnold..J.-_Kaplan............ ..................... at No.----•----•--•----..... -•----------------------•-----------•-----..........---------- Street. as shown on the application for Disposal Works,Construction Per o30. '.. ated. /z5 ........................ s4 9 Board of Health DATE...........................................................:----------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LOCATION S..E W A G E P E It hl N.D. ' VILLAGE ' - INSTALLER'S NAME i ADDRESS 777 R UIL0E R OR OWNER � ! U GATE PERMIT ISSYED DATE COMPLIANCE LSSUED r.. a