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HomeMy WebLinkAbout0070 PADLOCK LANE - Health 70 Padlock Lane Costiat Restoration 193-189 Centerville I llll 'PC 12543 HO. 53LOR - ASTINGS. LIN • o Commonwealth of Massachuseft �93 ug Title 5 Official Inspection Form Subsurface Sewage Disposal SyAam Fr„+rrn-Not for Voluntary Assessments O �Gr 10 c / Ro �J LvL ^ � i perly Address / '_'-------•---------...._�.a.._.. CW ner 0 VI! information is D^r ner s Name __ -e requQedforevery ,(� ll ? page. Gltylfown �2✓t`tWf/l l� - - Ate/ un � State ZI P Code Date ' Co 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. tnportart.When fUing out forms A. General Information on the computer, S� f�z 8ro use ony the tab t. Inspector. y to move oyour f cursor-do not � use the return ►� / © � �. key. Name of Inspecta Company Name Company Address � t? as Aly/Town �Oo / 2f o State /�D� _ T � Zrp Code Telephone Number • license Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage dispos I systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 R 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the local Approving Authority wzj ` � / ' U���='G� hspector' Signature we 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 i 0,GGO.god or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to tha 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. tSns•3113 Titre S Official inspection F omt Suburface Smage Disposal Sim•Page 1 of 17 S I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Dis"I System Form -Not for Voluntary Assessments Property Address a 4�t� OYv ner ;MTown er's Name e v information is requvedforevery C2w .yvy page. State Zip Code B. Certification (cons.) °e of�p��n Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) Syste asses: 7I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes°-, "no°or"not determined"(Y,N, ND) for the following statements. W"not determined,"please explain. The septic tank is metal and over 20 ears old*or the unsound, exhibits sub stantial infiltration or exfilt ation oranfk failure is imminent.(System or not) willstruc ss rally 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 thiat the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): tans•W 3 Title50rficiei Inspection Form subsurface sewveDispced System-page 20f 17 i Commonwealth of Massachusetts Tide 5 Official Inspection Form Subsurface Sewage Disposal System Form .Not for Voluntary Assessments Property Address �Q — d Owner Ov 4-0information is ner s Name /' I required for every (�e v`-kwi,J'L �/4 G1ty/ -oh page. Town State Zip Code Date of Inspection B. Certification (corn.) ❑ 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): ❑ The system required pumping more than 4 times a year due to broken or obstructed i s p pe . 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. I. 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 mannerwhich 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 t5ns•3H3 Tice 5 Official Inspection F cmc Subsurface Savage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address / Owner Le� lug information is Owner's Name required for every Cevjc yvl Ile- A4 00l page. 5WITown / State Zip Code Date Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil 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 ❑ 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 day flow tSns-3M3 Title 5 official inspecfim Fart[Subs Wam Seac-ge Disposal Solem•Pape 4 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address /aj119C, infomlation is Owner's Name f required for every �2vti�-�/w/�`lam �/"1� page. Qty/Town State Zip Code Date of nspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. (� Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 2<� 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 fleet but greater than 50 feet from a private water sup ply pply 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 am triggered A copy of the analysis and chain of custody must be attached to this form.] ❑ he system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails I have determined that one or more of the above failure criteria exist as described in 310 CM 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 `dyes"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. ffim-3n13 Title 5 Official Ins pectin F arm Subsurface Sewage Disposal S"M•Page 5 of 17 LO•C A T ION S E E PE. IT NO. VILAGE Let .02 INSTALLER'S MAE & ADDRESS f BUILDER OR OWNER r f DATE PERMIT ISSUED _ e_ 7 i. e - DAT E COMPLIANCE ISSUED r ' `7' a�p' f` t�� �J' �"� �`--, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 Z- Prope Ow ner information is lug rty Address Owner's required for every 6-e Ael'14 page. (aty/Town State Zip Code olatte o Inspectior� C. Checklist Check if the following have been done. You must indicate`fifes°or"no"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health components Were any of the system Y p nts pumped out in the previous two weeks? �S u as the system received normal flows in the previous two week period? ve large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system,obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components, excluding the SAS, located on site? Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. El Determined in the field (if any of the failure criteria related to Part C is at issue approximation.of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design):g ) Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): P-e/01 L - 29- d9" G!tee G Isms•3113 �� Tige 50ffidal trspeabonForm SuWWace sexdgepisposal symm•Page 6of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not fbr Voluntary Assessments yj // �� �yd /Ocher Property Address Owner information is Owner's Name r (� required for every Ce w'T'ew, page. City/To fn State Tip Code Date f Inspection D. System Information Description: / /000 6-ii / 1) 6 l e Number of current residents: Does residence have a garbage grinder? ❑ Yes L7 No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes S No Laundry system inspected? ❑ Yes ❑o Seasonal use? ❑ Yes Leo Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes N Last date of occupancy: u f11_&4 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15.203): Gagons 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: 15rs•3M 3 Titre 5Official impaction Form Subsurface Sewage Disposal S)stem•Page 7of 17 COMmonweab of Massachusetts Titre 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address L. / Owner information is Owner's Name required for every l ✓r'ice''v, Ar /� �p 6 3� /tf Jar page Crynown State Z�Code Date of I spe on D. System Information (corn.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: ' Source of information: �v 0 r— Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pu ing: Type of stem: 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(descri be): tSrs-&13 Tifle 5Omcial Inspection f ant subsurface savage Disposal system-page aof 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments vi " / O R operty Address Owner affomfation is ow naps Name ,� /_ / required for every �y l�v►' ✓r/`Ile- page. /Town State Zip Code Date Inspe 'on D. System Information (Cont.) Approximate age of all components, date installed(if nown)and source of information: ----------------------- 29 -- Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: feet Material of constructi;40 El cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): ? �/ Depth below grade: 7feet Materi of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) p ) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: __ x Sludge depth: t5ns•3M 3 rfie 5 official impeam Form Subswfaoe Sev0ge Disposal Sysoem•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage pi 20 sp WI System Form .Not far Voluntary Assessments Property Address Owner ON information is ner's Name required for every 2 Page. 3oZ �y/ own T State Zip Code Date Ins D. System Information (cont.) Pin Septic Tank(cont.) 7 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness /'y y �C L, V` Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle /How were dimensions determined? ° `� ' 41 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural inte , liquid levels as related to outlet invert, evidence of leakage, etc.): grity k v41 6✓! ✓0 O Lecx 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 Os•3H3 Tine 5Of ial Irspeclion f orm SubsWaoe SevAce Disposal System•Page 10 d 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not for Voluntary Assessments Property Address Cw ner -ew- information is Owners Name required for every G G k4` KV'j ` /%� �a (,fd— Page. atylT°wn State Zip Code Date Inspection D. System Information (coat.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, eHdence 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 Sns•3H 3 Ti0e501fidal ImpectionForm Subsurface SevrageDisposal System-Page 11 of 17 I' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo _Not far Voluntary Assessments d dlo ,k-, Properly Address Z--Il Ow ner Ow ner's Name information is required for every �y e� I/� Page- /Town State Zip Code Date f Inspection D. System Information Distribution Box (f 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.): SV/CS 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: t5us•X13 Title50f5aal InspectionFamc SubsrrfamSemgeDispasat SYMM-Page 12of17 commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not fbr Voluntary Assessments RopertyAddress � �� Owner Owner's Name infomfation is required for every e��` Od_ page- Csly/Town State Z�Code Date f Inspection D. System Information (cont.) Type leaching pits / number. ❑ leaching chambers number. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ inno vative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): v V Jl Y1s o �l S� �,•/ ll�r� Cesspools(cesspool must be pumped as part of inspection) pocate 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 t5ns-3h 3 riive5Official Inspection Form SubWam Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal S m y rn Forma -Not for voluntary Assessments r( O "'VjloC'0 PrOPerty Address . 6v owner Ow net s Name -Z 2 6- information is ,c� fage. for every Cep-I A4 ' ,L& ,3oL / r Page Cdy/f / �} D. System Information (cont.) mate z�Code Date f Inspection 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.): t9ne•3M 3 7 itle S Official trapecbm p omm Sebur{aos sere Disposel System•Page 14 d 17 Commonwealth of Massachusetts Title 5 Official Inspection on FormSubsurface Sewage Disposal system Voluntary Assessments U1W O / Property Address n r 0 G Ow ner e, inform tion is O"v ner's Name / required for every vi I/V� /�/j[ ��6�� // / ✓ page. Cy/Town D. System Information (cont.) State Zip Code Date Inspection Sketch Of Sewage Disposal System: Pm%hde 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 1 C —I�ISQr Ld- 0 da-02& M S3 c�3 tSns•W13 Tltie5 Official lnspectionFomc SubsurfaceSeerageplspwg S)sbem•Page 15d17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Ow nor Owner's Name /2 requiredfo s C requ'vedforevery 2 page. Aty/rowIn D- System Information `cost.) state ZI Code Date f Inspection Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. rY 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 ��served site(abutting property/observation hole within 150 feet of SAS) checked with local Board of Health-explain: ��G�s ,�- •TFSf f�/.ems ❑ Checked with local excavators, installers-(attach documentation ❑ Accessed USGS database-explain: You must descri how you the high ground water elevation: W , 4 N {i / / Coil 4Z Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5nS•3113 rite S officis InspeI Form Subsurtaw Sewage Disposal Syswm•Page 16 a 17 Commonweaffh of Massachusetts Title 5 Official Inspection Form Subsurfafe Sewage Disposal System Fo -Not for Voluntary Assessments Owner �Q Way is required forevery CPvrj Page. Ckyrrown M Report Completeness C �code Gate Ins �� hecklist '-� in'spection Summary:A, B, C, D, or E checked W P Summary D(System Failure Criteria Applicable to All Systems)completed SVI ern Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Ll •3/13 TAe5of8taelIPWIMF—SuDsW—SerageMV-d S.15MM.PW 17d 17 No THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � �3 Town OF......... arnstable (� APP iration for Disposal Evrko Tvngtrnrtivn jjrrmi# Application is hereby made for a Permit to Construct (x ). or Repair ( ) an Individual Sewage Disposal System at .- .Lot. $k 33 Padlock Lane Centerville - Location-Address ••----•--_..t.._ 0 2632 .........-.u f f o 1} 4�.3.�.: y...TX 11,S t...---•-•----- Pp ((�� y�r f(��fQ� or /L'1ot NMA­o. �y�T ................. .......^•A.S.l.A... Rf.�....3 N.\.i......�...P_.UlneX.Y.j.1.1P.................... W Kevin H' Owner a 1 C}iey........... .. Address ---•.................. ....-...7.-.�..�arr a Lame B r .ge--...a--me_.....alm Liable.. Installer __--•-._• Type of BuildingAddress 15, 540 U Dwelling three Size Lot......... ................Sq. feet a'-' g—No, of Bedrooms............................................Expansion Attic ri Other—T e of Building ranch ( Garbage Grinder fap) g ------ ...... No. of persons............................ Showers (2 ) — Cafeteria. ( rid Other fixtures ..................... Design Flow............J. 0.....----- --------------•------------------------- ......., gallons per person per day. Total daily flow........33II...........................W Septic Tank—Liquid'capacity.7.Q.Q0gallons Length................ Width................ Diameter................ Depth...gallons. x Disposal Trench—No........... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet........... Total leaching area......... ft. Z Other Distribution box ( ) Dosing tank ) `4 Percolation Test Results Performed by...............----• onald Gifford.................. Date-:-._�/..3/..7..8 a Test Pit No. 1_,C...2...----minutes per inch Depth of Test Pit...1.2.'-.. Depth to ground water. ?o#1-e........... �+ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... O ^� Description of Soil................•-•--•----•---- --.....--•---....._.........-----...---.......... --�`-2•---•--loam.._end.Bub o_�.�I.........................................................................................................................22�...-...1.1 COar -------•12-=...__.med-=---Sena----------------- C THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH 7f Town Barnstable OF FEE..../ . is rlor �t1 arks Tnns#r�trtion Permit ... Permission is hereby granted.............Kevin Hickey I •------------------•--.----••••........_..... to Construct ( }� or Re�ait33 � a Ind'vi al Sexra Di •----•---•................•--••-•----.._.._...._......................._. at No..._..--•------•--_- Lot 3 ac ].ocaneene vide............................. , MA 02632 ............................ ............. ass own on the application for Disposal Works Construction p strtetNo Dated.._ - ' DATE.-- s�?....._ ......... _ ---- _ Board of��pR� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ~ i ` m &-7f- No........... 9 FRs.... .................. THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH � �3 Town......................OF........Barnstabl e (� Appliration for Dismi al Works Tonstrnrtion Vamit Application is hereby made for a Permit to Construct (x ) or Repair ( } an Individual Sewage Disposal System at: -Lot # 33 Padlock Lane Centerville,... A _ 02632 ..__..... - • ------------------------------------------•--.... --- --------- Location-Address or Lot No. - Su f f o l k R a y_... ' LA ................................. .......Px.Q x... Q ...3.5� ..._.. e1a ,exy illy....... ...... Owner Address a Kevin Hickey„ ..... 7 ._Carr � e_•L ne••Barn._:tabj.p Installer Address Type of Building Size Lot....15,_540 Sq. feet a Dwelling—No. of Bedrooms............... three ............Expansion Attic ( n? Garbage Grinder fio) aOther—Type of Building ranch No. of persons............................ Showers (2 ) — Cafeteria,.( n4) Otherfixtures -------------....----------------•-------------------------------•-----------......----------------..-------- W Design Flow............1.1.Q.........................gallons per person per day. Total daily flow........330...........................gallons. WSeptic Tank—Liquid capacity.I.Q.Q Qgallons 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 ) ''' Percolation Test Results Performed by.....................onald__Gifford__.__-____________ Date.....2/3/:Z a Test Pit No. 1.4...2........minutes per inch Depth of Test Pit...1-2.'......... Depth to ground water.Miale........... (s, Test Pit No. 2..........:.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ••------...--•--------------•........---•-.....---------------......._------............----•-•••••.......................................................... O Description of Soil...............................�•-•---- i'......i OAM...and...aU125ail..---------•------------------------.....-•------..........---- V ..................................................•....-22� - . .�;.1. W -----•---------------------------------------------------1.1-. - 12 med aand............................. .................................................... 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 TITLE 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 1 alth. Si ed....... _, ? ......... .:�-- ------------ --, ...41 517 9.... Date cy Application Approved By..... ----. .... --....L61 ....... Date Application Disapproved for the following reasons:•--------------------------------------------------------------•---------------•--------------------------•-••-- ---------------------------------------•----•-------------------••--.......--------•----•------••-........---...._....---•----••------•-------------•................................................... +•� Date Permit No------------------------••.....-••-------._........----.. Issued---- �. `Date .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............Town.....I..........OF...........Barnstable ............................................ (Irr#if iratr of Tamplinnrr THIS IS CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) Kevin Hickey by..............................................--•-----------------............---••-•-•------- ......----=----•--------........-.....---•-----••-------.....................---..-.......-----.....- n�taller Lot # 33 Padlock Lane Centerville, MA 02632 at..-•-------------•-----•----------..._..--------------------....--•------------•--•-------•--- ---.._..--------•----------••-------._...---------•-.-.....•••--•---•-----------••------••-----•---- has been installed in accordance with the provisions of:T j of he State Sanitary Codes descrribed in the application for Disposal Works Construction Permit No.............dK__ ±..____....... dated__..►__ �`-_. .� _r_/_,f."'......._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector......................................................... THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH 7? Town Barnstable ....................................OF......................................................r............................... No......_ FEE........................... Disposal Works Tanotirurtiatt panfit Permission is hereby granted.............Kevin Hickey - ....- to Construct ( ortReair3 l�ac'].oc' " 'anew�a a'tpe°r�ville MA 02632 atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Pe it Xo . __. Dated.._j "J ._`. , "............ -------------•---- ----------- • Board of DATE------- ------ -�---��(•...-•-----•------•------•--------•----.....--- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No.................. l Fzes ..............++��« THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .Town Barnstable Appliration for Dh4p as al Works Tonstratr#inn Prrutit Application is hereby made for a Permit to Construct (C ) or Repair ( ) an Individual Sewage Disposal System at: Lot # 33 Padlock Lane Centerville, MA 02632 ................_ -....... ......._........................_.... ...... --•---•---------- -••--••........._...•-•---••--•----•--•------------------•------ ....... ._.......----••. Location-Address or Lot No. .........Suffolk Readty....Tmw&.-•-•--•-••---•-••-•--•-•-----•• •-•••..P.,.Q --.#307...34 ......Q.ent :rm7lle................. ...._ Owner Address W Kevin Hic_key _..__.. ?��._carriage•_Lane_,Barnstable_____________ a ....-----•-------•......_... Installer Address as 25, 540 d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms...................................tL�e _ _ Expansion Attic ( n? Garbage Grinder (jo) '04 4 Other—T e of Building ranch _________ No. of persons..... ..................... Showers 2 — Cafeteria no Q' Other fixtures ---------------------------------------------•••-- W Design Flow...... .......................gallons per person per day. Total daily flow--------.33.0..........................gallons. Septic Tank—Liquid capacity.1.0.0.0gallons Length................ Width................ Diameter................ Depth................ W 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 ) onald Gifford ___ Date.....7/3/78............. Percolation Test Results Performed by....................................................................... Test Pit No. 1 L.2.......minutes per inch Depth of Test Pit...12.......... Depth to ground water. QRIP-...._..__. fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •--•........--•-• ...... --•••....--•---•--...... ._.. .•• -----•••-••••••••••.............................•••.._..•..-- 0 Description of Soil.....:......................... ....2' .'. loam and_subsoil .. ...... ......•. . subsoil ` 2 1----'---11'------coarse_-sand----------------------------------------------------------------- ------ v --------------------=------------------------------------11 ----`-•�2........med--'---.sand---------------------------------......-----------------------------------•----•--•-- 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 i L 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. Si e .:_� _: _c� s -4,,--... ,mac.!/ 4/25/'79 Application Approved BY E'" ld .. yf "�j��► --•-- Date Application Disapproved for the following reasons---------------------------------------------------- .......................................................... ---------•--------------------------------•-•--------....._....--------------------------------...-----•---•---.........•--••-••••---•-•--••-••--•------•-•-•••--•••--•----••-•---••...------••--•--- Date Permit No..•.........................••--••-••••-•--•• t. Issued....... - >. ---Date .....•..... /a/9 0 . ` 30 '00-'�A4Z- SuBso,[_ • zc_x " �9 � 2/ � t 99 7 'EXIST/,t/� SOT"' IAO L.�� 89 E���. -kss��s,o v TES T HOLE - Z 07- 33 ieES UL_ TS F = � PER -- 0 w/i/ ,e E eoRZ)5 DP 7-E : / I LoTZS I Go r 2G SCALE : t TO IVAJ l✓P1 TER / s A VA /L. 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