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HomeMy WebLinkAbout0034 POWERS DRIVE - Health 34 POWER DRIVE, CENTERVILLE A = F LOC-ATION o SEWAGE PERMIT NO. �0�6 VILLAGE A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 BUILDER OR OWNER r� DATE PERMIT ISSUED )� '�" DATE COMPLIANCE ISSUED � __ �e� r � � a �� � �� `oti n -�- . � �� _. . � _ _ � . No......-. btf'.... Fim........$ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................T.cx R............OF.....I..............Baxwtabl Appliraffou for Uispniia1 lVorkii Tomitrnrtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: .....CeJlte�' lle, -a 0262•• ........- ._....-- Location-Address or Lot No. _RichardSily ______•-_.••_____._•___„•,•__•--______,- 4_.Powers Drive, Centerville. MA _02632 ..._ .... ....... Owner Address aA__& B Cesspool_Sermice_, _Inc___________________________ __ .....................8 Bisops Terrace, Hyannis, MA 02.6�__2_ Installer � Address UType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms.......................3...................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons.....................--.---- Showers ( ) — Cafeteria ( ) a 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 ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.---.............--.---. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---..................... ------------------------------------------------------••-•----------.......•---._..........•.-•----......................................................... O Description of Soil Sand U •--•--•----=-------------------------------------------•---•---•-------------......----•---------------•--••-------------••---•---------------•-------•---------------•--•----------....---•---------- W x ••••••••--•••---...-----•...•-----•--••-•--•-----------•-----•--•-••----------------•••---••-••-••------•--•-iris fa71a iori.-o --a-1--Half-----aIIori---•Pr"e•=cast, U N ture of Repairs r Alterat}o —Ans er hen applicable................................................................--.........................--. stone packed each pit OverRowj. •-------•-----------------------------•----------------•-------------------------------•----------•----•---....-----------------------•••--•--------•----------•------••--........----•---•-•-•••.------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1 M 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-theboard, f 1 E31th. Sign./!..� �y'.l`_..� � .... 71 / - / p ApplicationApproved By-••••---•--.......--•-•f ...•... ................................................................ 7..1 .2.. 4....._.._. Date Application Disapproved for the f of wi reasons-------------•---------------•-•--------••---•----------•--------------- ------------........................... ---------------------•----•-----------•-----------------.._.._.........--------.....---....-•-•-•-----------••-••--•••-•-----------•-----•-----•--•-•-----••----•-----•--•......-•-•--••--••-•.....---- Date Permit No..........................I ........................ Issued----•--•---.._......7/12/84................... Date No.A.4b�.... ... ....15.00....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................T1W.n..... .......O F...................BaxMtabla........................................... Appliraa#ion for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: . 1_.P.c ,t$rs_�r3 ua,..I+enberY311> ,..NA----.02632.... ............•-----••------•--••--------...---------...------•------•---------..............------. Location-Address or Lot No. Uchazrl -1 -------•---------------•----........---•----------..•.....-•---- 34-.P.ow�sxs.lrlYa,..�er[t�erx9.11e, v,.....� 3 ...... Owner Address a .A... ...Ina-............................... 128315hops..TexMCe.,...H,j!a=J_s,..?!A.....0263-2...... M Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms---------------------3....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.......................4__ Showers ( ) — Cafeteria ( ) P., Other fixtures ................ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___..•-----•_----__-sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... (.%4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................04 `. --•-------------------------------•-..........---------.....-----•---------.....----------.._............................................................... 0 Description of Soil........................Sand......................•--•-••--•-----•---------------------------------------------•-------.......................................... W installation of a 1,400 gallon, pre-cast, U Nature of Repairs or Altera io s—Answer hen applicable............................................................................................... stone packed leach pit overrlowyo ----•----------------------------•--••-•---•------•--------•------•------------•-------....--•--------••--••-----------------------•---------•--------•------------•--•--•-------•--••----•-•----...... 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 thqp d- f l lth. / ......S.. .....VVA4..... ApplicationApproved By..........-------••--•-••---••-------.....•--------------------•••-•--••-•----•---......_........ ............Vol ........... Date Application Disapproved for the following reasons--------------------------------------------------------------•----------------------•------•----•----•-----•--•- -••--•-•---------------•---------•--------•••._...-----•-•--.._............---------•-•-•-•----------••--.......•-••------------------------•••--•----•-------------------------•-----------•---•--•..... / Date Permit No......................... '---------------------•--. Issued................... 12/84................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... T own Bay table ...............O F...................................:................................................. (9rdifirate of Toutplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (K ) by....A-A.R... � .Q�1... xv ea Zr�� .,...128--316_t1-QPS...0 00.,...IiY=1A,..MA....Q2.dQ;:.. Installer at3.4.13 rers__Ar xe,..0 z� Q v l�e� r !_.._..0_32.. Ri 3 has been installed in accordance with the provisions of TITLE 5 of The State Sanitar Cod as described in the application for Disposal Works Construction Permit No8"'.................................. datedl128k___---_____-___-.-._-..__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .........................................OF..............................................I...................................... Disposal Works TWInstrudivitUprrmit Permission is hereby granted------ OE�S, j?QQ1.S�Z'Y�.0 3,._IYl�x-----------•-•---------•------------------••-•----•--.......-•----. to Construct ( ) or-Repair (X ) an Individual Sewage Disposal System at No....34.2owers_.�2r.3.Ye,..G�mt� tl�l. aa -----02632..-.RiQhard..n1y. Street gl_ 7/12/84 as shown /thelicati for Disposal Works Construction Permit No ...... .......... Dated.__._......____ .................._...... ------•--••--------- ----•--- Board of Health DATE.2 -�----------------------------•-•----•--•---•-------- � FORM 1255 A. M. SULKIN, INC., BOSTON a6521 Commonwealth of Massachusetts as 61 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Powei8briveq� Property Address Paula Sullivan r`a Owner Owner's Name l�* information is Uri required for every Centerville MA 02632 1/24/15 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return Name of Inspector key. , y Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 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 disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails I Needs Furthe E aluation by the Local Approving Authority 2/12/15 Inspe s Signature Date The s s em 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 I at that time.This inspection does not address how the system will perform in the future under 00 the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 •C I Commonwealth of Massachusetts W Title 5 Official,, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w, a 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check. A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3.10 CMR 15.304 exist. Any failure criteria not evaluated are indicated below, Comments: I . 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. 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): I . t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Aa 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date 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 p.ipe(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): 1 t I i ❑ The system required plumping 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): i I C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist whichl,require further evaluation by the Board of Health in order to determine if the system is failing to'p'totect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Mas$,�chusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i� ^M 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of 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 6eptic tank and SAS and the SAS is within a Zone 1 of a public water supply. i ❑ 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: ' <. I I i� D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No El ® 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 Y2 day flow t5ins•3m Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Y. W Title 5 Official Inspection Form Subsurface Sewage Disposa f l System Form -Not for Voluntary Assessments , �M 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection 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 boirt'ion 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- 10,0006pd. ® 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 mu.st1ndicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No i ❑ ❑ 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 "yej7 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 witlj 3.10 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 i, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official; Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 34 Power4Drive r' Property Address Paula Sullivan Owner Owner's Name isrequired for every Centerville MA 02632 1/24/15 page. City/Town y 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 4 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were ny.of the system components pumped out in the previous two weeks? V . ® ❑ Has tl�e 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 in6pection? ® ❑ 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 s'ze and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existinginformation. For example, a plan at the Board of Health. ® ElDeter�ined 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 i Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 i r S ' l5ins•3/13 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i r Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: l Number of current residents;. 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) f ' ❑ Yes ® No f Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/industrial Flog, 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 El 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•3/13 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 `I; r - Commonwealth of Massachusetts W Title 5 Official.. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�A.a,• 34 Power4Drive Property Address + Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/uso: Date Other(describe below): t General Information Pumping Records: Source of information: Tanks were pumped a couple months ago Was system pumped as pOrt.of the inspection? ❑ 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 sysstem (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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Power4Drive Property Address Paula Sullivan ; Owner Owner's Name isrequired for every Centerville MA 02632 1/24/15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all co4ponents, date installed (if known)and source of information: 1000 gal. tank in 1984-galleys were installed in 9/24/99- 1500 gal. tank was added in 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: " . feet Material of construction: ❑ cast iron ® 40-PVC ❑ other(explain): Distance from private water.supply well or suction line: feet Comments (on condition of.jo.ints, venting, evidence of leakage, etc.): is Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain). 1000 gal. H-10 was 18" below grade. 1500 gal. H-20 was 12" below grade is 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. & 1500 gal. Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Officia'I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information fired r e every Centerville required for eve MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) F Septic Tank(cont.) Distance from top of sludg to bottom of outlet tee or baffle 27 Scum thickness i, Distance from top.of scum;to top of outlet tee or baffle 6 15 Distance from bottom of scum.to bottom of outlet tee or baffle How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present. There was no sign of Ieakage.The scum was minimal both tanks were pumped couple months ago.: i .. f (i Grease Trap (locate on site plan): Depth below grade: n/a i feet Material of construction: i ❑ concrete ❑ meta:( ❑fiberglass polyethylene ❑ other(explain): Dimensions: t: t Scum thickness u Distance from top of scum ko top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I , Date of last pumping: Date (Sins•3/13 ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i, I ` i Commonwealth of Massachusetts 1. Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name isrequired for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): a . a; i� 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 . El other(explain): N/a Dimensions: r Capacity: gallons Design Flow: gallons per day Alarm present: El Yes ❑ No Alarm level: — Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): I *Attach copy of current puCrtping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Offici!l' Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above:outlet invert n/a 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): I Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ; ❑ Yes ❑ No` Comments (note condition'of pump chamber, condition of pumps and appurtenances, etc.): N/a i 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: f t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 12 of 17 G I ' Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a,• 34 Power4Drive I' Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: i ❑ leaching pits' ., number: ❑ leaching chambers number: ® leaching galleries number: 4x4 galleys - 12'x36'x4' ❑ leaching trenches number, length: Y ❑ leaching fieGds number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system .Type/na.me of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The galleys were dry and clean. Galleys are in the driveway and are H-20 per as-built.There was no sign of failure.The galleys were 6.5' btg, and the cover was 30" 9 k Cesspools (cesspool musf be pumped as part of inspection)(locate on site plan): Number and configuration l 11 Depth—top of liquid to inlet'invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater ioflow ❑ Yes ❑ No c. t5ins•3/13 l' Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �. . �,•'• 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 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.): 3 ;ll C, 4, Privy(locate on site plan)f' Materials of construction: h Dimensions Depth of solids i� Comments (note conditiomof soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a is i, r 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 P r Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. City/Town 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: i ® hand-sketch in the area below ❑ drawing attached separately 11Ara � mit• - I . l�l.lu I a l ,r O 3 Pr o � �b t r4 F', r�x36xy ,ar alp -fl y GAIpt' s 3 ► g 1 g .D s � O y yo t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r c% I't Commonwealth of Massachusetts Title 5 Officia'IInspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' a 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name information is required for every Centerville MA 02632 1/24/15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope I 'i ii ❑ Surface water j ❑ Check cellar ❑ Shallow wells 20' + Estimated depth to high ground water: 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: 4/17/2006 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 USES database-explain: You must describe how you established the high ground water elevation: design plan shows no water 10.5' below galleys ; r I . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i f . r 7r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Power4Drive Property Address Paula Sullivan Owner Owner's Name required for is every Centerville required for eve MA 02632 1/24/15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist M 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 I. i� i. E� 1 i I ' t5ins•3113 - - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �' o0 No. . 014— Fee 25 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Migpoal i§pztem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( )<'Aba7ndon i() Complete System Individual Components Location Address or Lot No. 34 OW>✓�Q 17fL Ow s Name,Add ess,and Tel.No. Assessor's Map/Parcel e33 e el A v5L"l t LLC Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.5L LLa v&,,j !EAJ�, �"C. rl 9-0Q4 05 -kC2d1C.UZ Type of Building: 1/ i Dwelling No.of Bedrooms Lot Size I"2 A,L Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date A h7 d(o Number of sheets Y I Revision Date 9lZS�Q(o Title �3► rF_ ?LA GU O_Uycr,6 r) Z.4&Zfo G AA P•G E� Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) A Q.61,_xPO► A `.EAC--K ?r l A Sit 5CO U eO\_ j?k s Er-OA kitY 51=9n C_ sY!9, wl. ��,n��c Y Sys►� �,ry U IUC 161�aiE___0 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance w'th the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Co 1 li n e I be issued by this Board of Health. Sign Date pplication Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( by r� at '34 �OVye-L FV2\U G ,✓`tit I Liz, ha een co structed' a ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved n flow gpd The issuance of this permit shall of be co jstrued as a guarantee that the sys m will fun n �igne�d. �. Date � �b Inspect -------- _-- - --� �-��-------- No. ------------.���-�..-�~` Fee -�---- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ligofsal i§pgtem Construction 3dermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( K) System located at 3� �i,�E(L 1yrik v E nC-r..l T-f=�,4 i L-C 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 Approved by No. _ j � Fee f - - THE C...v WEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Migoal *r!5tem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon©O Complete System Xindividual Components Location Address or Lot No. �OW E'2- 1�Z Own e 's Name,Address,and Tel.No. C.stitTtV_./It-trE ra,ut.P, SuL-tr\VAti-4 36, ?6wec'., Assessor's MapTarcel e, 3,3 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Svt_c,v o v.) �+�. "C Z ?n Z qZ 0-0 ivy y OS Jr- 0>1)LLLr Type of Building: Dwelling No.of Bedrooms Lot Size VL.kL sg4tr Garbage Grinder ( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 11 Plan . Date 4 h-r f OG Number of sheets ��( Revision Date W2 j�p t , Title S �?t, T .A IU ?1?0?t�6D Z4 XZt. GA a'_A.6 E_ ;A Size of Septic Tank Type of S.A.S. Description of Soil 3 _ Nature of Repairs or Alterations(Answer when applicable) Ae66► PO►-A LE^c� ?(1 A V)SC.O t o tEC7, PF- Feo m s aot A ke-Y 'o ►aGtAA1046(ec) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. l Jl.�� Signe 1 ,,y/ r /p /.1/? .- Date v Application Approved by /// �/!�( V��� � �� Lfi(, / _ Date Application Disapproved by: Date for the following reasons Permit No. ( Date Issued - r T'— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( _�by �t at ��} Olta FEZ 2�li t; l ,Cr t T �Lr( f 1..�G has een co st'c�tJedP accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �•1', dated Installer Designer #bedrooms Approved d.,sign ow gpd The issuance of this permit shall o}f be co•strued as a guarantee that the system ill fun 'o des'gned. Date Inspecto -- --"—"—=---------=------------=---�j--. No. ( IG� Fee / THE COMMONWEALTH OF MASSACHUSETTS -_ PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS ligoml 4pztem Cow6truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( K) System located at qW 1✓tZ FN reQ.,(i t_ -C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricaction for Migaal *ymem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon) 0 Complete System ❑Individual Components Location Address or Lot No. 3 7 L�C VIP/ �� vp Owner's Name,Address,and Tel.No. QUIZAssessor'sMap/Parcel Q IS(4-1114/4-�^ Y wer ,-lY/e CeA Installer's Name,Addryyss,�and Tel.No. Designer's Name,Address and Tel.No. Skll j(,Cv n�. ve�� �•ob�ot �S ,� �/ sertu�-( 7 Fb�gyp,- l�,•v� DS�-ev�1llP Type of Building: Dwelling No.of Bedrooms _ Lot Size 7 C sq. ft. Garbage Grinder (A(/ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ^Design Flow(min,required) gpd Design flow provided gpd � Number of Plan Date / 09 sheets (// Revision Date L 46 Title U 2 X Gv, Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(An wer when applicable) ^ 0%S42 0, 2e Date last inspected: Agreement: The undersigned agrees to ensure the construction and aintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the viron al a and not to place the system in operation until a Certificate of Compliance has been issued by this B alth. Signed Date Z, 06 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer. Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS M.5po5a[ �§p!5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by I -. ., _ h. :y:s M1 y ...--,a•�w ri�•y.: r '.1'v°v.:Ywa.-+-..... _r .. .. ,.- .. .... �,� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for �DizpogdY �&p!5tem Con5truction Permit Application for a Permit to Construct'( Repair"( )pgrade O Abandon ) ❑Complete System ❑Individual Components Location Address or Lot No. �� ��F !�/�u r;' Owner's Nanle,Address,and Tel.No. Assessor's Map/Parcel ? Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 Type of Building: / Dwelling No.of Bedrooms / Lot Size 11Z C sq. ft. Garbage Grinder (//4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ;P, - Design Flow(min.required) gpd Design flow provided gpd -Plan Date 1-///710� f Number ofsheets Revision Date 9X��%G Title P/1�1t''' �� �- `� tf X �; Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) bu 17 D ' Date.last inspected: Agreement: d The undersigned agrees to ensure the construction ands. aintenance of the afore described on-site sewage disposal system in ^� accordance with the provisions of Title 5 of the.=Environmediffal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo9FdjofHealth. Signed,,--- Date / ea Application Approved by /,lG`��'� Date Application Disapproved by: Date for the following reasons Permit No. N Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (' ) Abandoned( )by at .�-^"—has been constructed in accordance with the provisions of Titlef5 andYthe.for Disposal System Construction Pe it No. .. dated % .- Installer Designer_ #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lisspozat *p$tem Con.5trUction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date Approved by t1 , TOWN OF BARNSTABLE LOCATION 3A%yi ee714,oV L SEWAGE # ZOO(o-I W) VILLAGE Cc-ArGR 4i WS f ASSESSOR'S MAP & LOT 1(0 033 INSTALLER'S NAME&PHONE NO. .79-X SEPTIC TANK CAPACITY %!M GA t,t.O AAA+ LEACHING FACILITY: (type) 4x4 I�.QACktwyr- (a -Lt_ J (size) WX%'X4 NO.OF BEDROOMS {J C s E& W 4(0e.) BUILDER OR OWNER T.ca U LA S V LL%VAM (Ova" PERMTTDATE: I $ bCo COMPLIANCE DATE: Separation Distance Between the: GQw 41ZfL j v,,AA Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 10.S Feet Private Water Supply Well and Leaching Facility (If any wells exist TAA4 on site or within 200 feet of leaching facility) 150, Feet Edge of Wetland and Leaching F c' ' (If any wetlands exist GP.GAICV--rtW-%A within 300 feet of g ty4 350 ` Feet Furnished by l- Fes. NOW t �Dw QU-A&Cr Aoo mosi A 14' It VOW � c I'Vo. �®�' �� � Fee S�J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Mi5po5at 6p$tem Construction Verna Application for a Permit to Construct( ) Repair( ) Upgrade(b4 Abandon( ) ❑Complete System RLIndividual Components Location Address or Lot No. �j �( j L �/21 V Owner's Name,Address,and Tel.No. �n ?A,L> A Assessor's Map/Parcel 1(p7 /0'3 3 ^4N,f'�• Installer's Na e,Address,and Tel.No. Designer's Name,Address and Tel.No. :Nt d, `-P' : ULLAVA.Q 1✓r`7G 1Wk(!a LW.. 6 kkJ_C .?7/se4CJiu . 5 �✓tee ,1 C� �2V1 iC,C Type of Building: Dwelling No.of Bedrooms A Lot Size ��2�L Garbage Grinder (4�D Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date A eiz%t_ a)zoo 6 Number of sheets 1 of A- Revision Date przQ C Title G 1 to?LA,�u TeZ Ras g;C> A p z>c Tw" F02 &L)L.A SUL.L w po_. Size of Septic Tank L,:�C>0 C- UO'LL0 t J Type of S.A.S. ll x'-�>G X 4 i L.CTALLG,1,S Description of Soil CLC—P�r a SAS&A O Nature of Repairs or Alterations(Answer when applicable) Ar,>Q \ 5-oc [�P L lA Ut �k-2,0 SG$_kj 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 Environme Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f h. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 006 Date Issued (� v I ryNo. ' Fee U/ THETCOIIf�MONWEALTH OF MASSACHUSETTS Entered in computer: L PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for �hgponl'*pgterrY Construction Permit { t Application for a Permit to Construct( ) Repdair( ) Upgrade($4 Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. ?j �dV.] �,Ztv C: Owner's Name,Address,and Tel.No. FAU A SUL.L\VA,_ Assessor's Map/Parcel f p 7 ', ,V•�� 3 puJ C 2�,—Cc Installer's Name,Address,and Tel.No. S Design -NameA�d .e d Tel.No. j- ..��/d�l:f, SULK--tVA.Q tiGk►�C 2tKA6 \ikc Type of Building: Dwelling No.of Bedrooms A Lot Size �w✓2�Cr sq=IL Garbage Grinder (4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures xJ Design Flow(min.required) 4�..n gpd Design flow provided /A(a 2. gpd Plan Date AP2t L l7,T Cam)go Number of sheets 1 of J- Revision Date N oQ c Title S1r'E-P,_A,1t SPlJR -f, t-nQx.( Me.. &L.) A 9UL.LkU&A•..l Size of Septic Tank i SDQ 6•TALl..0&J Type of S.A.S. EKtST1 J�1f-r 1 Z is fn k L 62CAI,l.,1.,�( Description of Soil Ct._>=,A,as SA n.1 Q Nature of Repairs or Alterations Answer when applicable) ^^ S-_= TA mac {, 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 Boar Vfe th. ��Signed —, n Date / , Application Approved by R. • Date y/lklo(o Application Disapproved by: Date for the following reasons Permit No. ;. 006- 16 Date Issued / o --___-____ T - _-___-__-_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded a Abandoned( )by at 34 r b"1,3(=t' 2��)C =.loll cl f C ( tom^ has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. a�D6 I!D dated Installer Designer SVLL\UKN ��. \m C_• #bedrooms Approve >desig flow O gpd The issuance of this permit shall of be co tstrued as a guarantee that the system will fund 'on as esi ned. Date ,; fo Inspector -------------------------------------------- No. O 6 ' (0 Fee - THE-COMMONWEALTH OF MASSACHUSETTS— PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=i!6pogal *pgtem Construction permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (X ) Abandon ( ) System located at 3 A FO\U C �Zt V 1E CcN TZ�Q,! t LL.La 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: Cons ruction must be completed within three years of the date of ermil. to . Approved by ,�Date pp i nie Town of Barnstable Regulatory Services g rY ��� Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601, Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: S/24- oho Sewage Permit# 200�.-1(a9 Assessor's Map\Parcel 1 C 7 033 Designer: S VULW An+ ZaG c"E QI A3a I M—c- U. taolet: 317 --���d�cs'� Address: 17 lL.o c� ame-vi�tr Address: — � � On A f 1 a/oG was issued a permit to install a (date) (installer) septic system at 3 4 o w Ee*_DQ 1 v a L_mM0_V1 PLC- based on a design drawn by (address) dated KP¢.I L-"l ?-COG (designer) _ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e.greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations revision or certified as-built by designer to follow. 07 Z MR ��ign ature SULL1d�1 29733 CIVIL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.THANK YOU. Q:Health/Septic/Desiper Certification Form 3-26-04.doc L�r 3 t'J, TOWN OF BARNSTABLE q� Q LOCATION � T C)W CC- P2\U ' SEWAGE # ✓oF�6 C� VILLAGE CC V( LL. E ASSESSOR'S MAP& LOT 107 33 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LCC0 GAu o"_S LEACHING FAciLrTY: (type) NO.OF BEDROOMS__ L 6ECE ,$��'Gc�(o Foe SYSTEM:w BUILDER OR OWNER 6UL Lt U Ill..11 { PERMPTDATE: 7-20- `�e) COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility eAteCr t1^ki S Feet Private Water Supply Well and Leaching Facility (If any wells exist Mc � 2�0 on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist _ within 300 fee "t leaching facili %vt TM"A WO Feet Furnished by �— o � d p, v x � # y O M r .zMs; i 14\ ITJ N cw 'rNtO FT 1 1 v d. 25 - No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: —VIZ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for �Bigponf *patent Conotruction Permit Application for a Permit to Construct( k)Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Q,�v Lam_ 2 O rs Name,A9Aress and Tel.No. -426-00-4D Assessor's Map/Parcel ; w ��o l II.-LKincyt L_L(F— Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Za" C�wrvt)cvio t, s�LL,.,�,w t �tt� etn� 1►� Type of Building: I Dwelling No.of Bedrooms Lot Sizeft. Garbage Grinder(tAe Other Type of Building No.of Pers ns Showers( ) Cafeteria( ) Other Fixtures Design Flow Z;/AQ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Lk+ =,S T MgtEO SYAA� (Zyj0EX_- — ),3 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been 's ed this Board of ealth Signed Date 0 Application Approved by -- �.,,_, Date '7--) •-� Application Disapproved for thVfollowing reasons Permit No. _ Date Issued ---------- - ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ) Upgraded-( ) Abandon )by at ELF l7EQu has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. OK, 15� dated Installer A Designer The issuance of this it s 1 construed as a guarantee that the s sic will funcpo as igne Date Inspector n 61 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1wi.9pozaf *Pztem Com5truction J)ermit Permission is hereby r nt o Construct Repair )Upgrade(' )Abandon ) System located at 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 b complett.d hin three years of the date o i isRFrmit. Date: c_ )/ D '�l Approved;by ! ) / _ J, IME T° Town of Barnstable Board of Health s • BARNSI'AB[.E. � P.O. Box 534, Hyannis MA 02601 ATfp�,�p Utttce: -)U2S-662-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health MAIL TO:TOWN OF BARNSTABLE PUBLIC HEALTH DMSION 200 MAIN STREET HYANNIS,MA 02601 FAX:508-790-6304 w < SEPTIC SYSTEM INSPECTOR REGISTRATION' ate- ��• Date ' i Name of DEP Certified Inspector Ta to K�-Business - Business Address GKLeerJV1Ue -bKlue Foes-��,�IQ A • ©2Gu� Business Telephone No. 506 FAX Number Home Address 6G GKee0\104 'bPov.t. �MA • °��4`l Home Telephone Number S-08 The undersigned agrees to comply with PART VIII, SECTION 14.00 of the Board of Health Regulations. `The septic system inspector shall complete every applicable section of the"Title 5 Official Inspection Form-Not For Voluntary Assessments,Subsurface Sewage Disposal System Form," supplied by the Massachusetts Department of Environmental Protection. In addition,at the bottom of the last page of this official inspection form,the septic system inspector shall provide a sketch diagram showing the vertical separation distance between the bottom of the soil absorption system and the groundwater table along with any high groundwater elevation adjustments determined. The Septic System Inspector shall submit a copy of the completed septic system inspection report along with the required processing fee to the Public Health Division Office within 30 days of the inspection �date.` . Signature of Applicant FEE: $25.00 per report submitted to the Public Health Division Office beginning September 1,2001. TOWN OF BARNSTABLE LOCATION ® �� ��\U SEW/AGE # �"Q 6 VILLAGE CCN1TICN/1 l...(— a ASSESSOR'S MAP& LOT IG-7 !;-"S INSTALLER'S NAME&PHONE NO. LC.I Eq C01,A ST eM710 0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 12 X 34a, X g' L C—At A, S C K-? NO.OF BEDROOMS C SECE 84-4C* BUILDER OR OWNER PERMITDATE: `7"ZO- 56 COMPLIANCE DATE: —�4"dq Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility���TWA14 `� Feet Private Water Supply Well and Leaching Facility (If any wells exist Mor2�Tl�sl Zpp 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) �''C TM'M WO Feet Furnished by (_� � I 0 4 2S g3 ?S / 4 t� � �4 3D ►� loco Z tivv�t� ��u�Hw� Y L�60 t A DEUG a7w��n� c F =tv eo e13 �vw C=-2 ���V l: 12X3laxg �{ 26 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS Yes Application for �Dtgpooal 6potem Construction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 54 Q\4-�, Q2 O is Name,Ad ress and Tel.No. -A28-CO440 Assessor's Map/Parcel I�-7 A 6:e li�_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1G11=�� LA I�cvi01� �ULL�vp.v.� CnIW tNG li.9G Type of Building: h Dwelling No.of Bedrooms Lot Size Garbage Grinder(JAC) i ;� Other Type of Building No.of PersA s Showers( ) Cafeteria( ) Other Fixtures Design Flow 44U gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 0 (0)F—CL)kl D VQA j _ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ed this Board of ealth Signeds, Date Application Approved by Date 7-J- Application Disapproved for th following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired P�)Upgraded( ) 0'Abandon%443 )by at ff2- AjL C Qj EQ\/1 LL.(, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,,r1 � dated Installer Designer The issuance of this t Oqt construed as a guarantee that the s st will func ,o as I igne Date Inspector No.r C Fee _f THE COMMONWEALTH OF MASSACHUSETTS- Entered in computer: vy' PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS } 0(ppYication for Mfgpogar 6pgtem Congtructfon Permit Application for a Permit to Construct( K)Repair( )Upgrade( )Abandon( ) ❑Complete System D Individual Components iLocation Address of Lot No. O er's Name,Ad ress and Tel.No. , 426—CO.40 �Y� C T cr cao t�-0 %U74,j Assessor's Map/Parcel I.C77 34 CQW�1? , 33 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l►SA�at1;M0C710 6—' SUe-L�vP,cv C—:OJGIl OE 7:P—(VVG IYJG Type of Building: Dwelling No.of Bedrooms Lot Size 12 - Garbage Grinder A(y) Other' Type of Building No.of Pers ns Showers( ) Cafeteria( ) i Other'Fixtures i ,Design Flow 4 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank, Type of S.A.S. Description of Soil (...LAIE, 'St°<O Q D W+41112 Nature of Repairs or Alterations(Answer when applicable) ' - t 1 Date last inspected: f� 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 's ued this Board of Healt -'� c_ Signed Date Application Approved by Date -7-fib - a Application Disapproved for th following reasons r Permit No. r Date Issued r --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ., BARNSTABLE, MASSACHUSETTS y Certificate of Compliance r/ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired )Upgraded( ) Abandon )by at 3-� OI-43 152, QJ (C_L_.t= has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No., y t� dated Installer ' I Designer The issuance of this t,4 a1}� of be construed as a guarantee that the s s will functio as ciesligne, Date / (,�( Inspector r — (�---C—�— ---- —_==---- --------------i— No.— ZS V —— - Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mfgpogal *pgtem Congtruction Permit _ Permission is hereby rant�to Construct Repair( )Upgrade( )Abandon ) System located atOw EE�_ rZ C1�T��'_�ll ILL 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 o is\ rmit. l 4�7 Date: ! Approved by IlAO P� Lo 3 TOWN OF BARNSTABLE q� Q LOCATION 34 ®& i✓Q, SEWAGE # ✓ '� C7 VILLAGE ASSESSOR'S MAP & LOT G7 33 INSTALLER'S NAME&PHONE NO. LC ZQ SEPTIC TANK CAPACITY LEACHING FACII.TTY: (type) _L?-k 34, X A' L L ABC,&A,,V�c NO.OF BEDROOMS S eL g -GCS' Fob 5Y5+>r rho BUILDER OR OWNER 6ULL U k" ' PERMTTDATE:_7_ZO- COMPLIANCE DATE: L Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility�� �4 Feet Private Water Supply Well.and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Mo Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee leaching facility.) , e �L�i�1 3GtiJ Furnished by_ �� Feet N J p t� CNN \ (�0 - vf � imn Zoning District RD-1 r. T. Setbacks 30/10/10 Proposed 24 x 26 Garage Flood zone C of . 4 - Av,> Lo z;—, LOCUS /_�!�► ;�c j1 I�`JI i ls7}Pj� `Z21,;S PWE BA5KE'TC3A1 t_, f/ r to . LOCUS PLAN �tQbT QtT o Scale:I"=2000' \q cfl_ � �'L L �,5 (�-IO,SS9� Assessors Map 1 Parcel 033 Groundwater Overlay 1 �SO�.fA � t T ti p se-P,L District:AP t t t ® 4 Flow Design g o Bedrooms No Grinder t-:9 5-,CyULL FUN \ i ' `i Existing System: Leaching Galleys 12x36x4 Allowable effective depth of system 2 feet only i N 5 cCiV 1 C E ^• I s�TTt� -P.w\\t To 1 r Bottom area 12x36= 432 sf S23 A,ICN tN 54-1-zv\cE1� I ` N I i � 44 ' 1 Sidewall 2(12+36)2 = 192 sf Total 624 sf t N EX\ST.E K L i 1 II 1/ Total Flow 0.74x624= 462 GPD 7 � 1 a1 0C • I ! b 0 ( i I fit ( t r r i ovvsL L;n:Cr �- H,.'',a.SerneniT40 I OF TI M CER bEG1� r ' A� F t� I % r i 1 U00.2973 3 CIVII. i:.X T. t ';<3C� r 1 -EAC-1-,\N<c GALLi-,i 1�,�\VEWAy � �' � � %( i t , 1<_:J•sp,�l t.,v SEt ✓,�E ,s , IYI r ' Concrete -t o _ _ ht a i P ? S97 Bound /Elev. 36.18 �, Site Plan r /� � -� �,,,,.;��1 Proposed 24 x 26 Garage r i � � for: Paula Sullivan PLAN VIEW POWERS �\ M° a at: 34 Power Drive Centerville ,r DR/ICE Sullivan Engineering Inc. Scale: I = 20 Osterville MA Revision: Sept. 25,2006: add garage Date: April 17,2006 - 2� 02Iq ran ry= -- Zoning District RD-1 ; Setbacks 30/10/10 r Flood Zone C .••� . o .' o l 3/2.04' N A �.ae" Comae LOCUS ✓/�° , 212.44' 3�Z�S�` Ex1ST• �- SL,of�j ;Im ._ SNEO I EL 30 9 , •• (r v`i °_ - rudder - O.SO Ae EX15T, PAVED 6nSKET6AL - mil Bay 1 2 s Au-SY5 Z L 2� TO r? " Bo :j-�- Jill o Ex 1ST, 1 000 GAL LEACH I^ ' PITSTOREMNN IN 1 SERVICE. SEwc6E ` LOCUS PLAN Scale I"=2000` 0_ Assessors Map 167 M K1 1 I Hl f "1►Z-07t La OC SYS�IvI NO V IA�CZ- Parcel 033 M \ Sr-s LS Distr ct:AP Groundwater Overlay 1 A l Design Flow 4 Bedrooms No Grinder. CX I ST,BU L.L RU N \ I ' I i ( Existing System:Leaching Galleys 12x36x4 VALVE• TO ReMAItJ , , J -IN S6.RY\CE Allowable effective depth of system 2 feet only , � t ExIS.T, 1000 GAS 1 SEPTIC TA-UK Tor E , t ` Bottom area 126= 432 sf REMAIN\N 9E('iV\ ' —e� x3 ' I I Sidewall 2(12+36)2= 192 sf Total 624 sf L --I I , I l Total Flow 0.74x624= 462 GPD Lo DECK. Il l 2 FtSMOVE EXIST TIMBER (DECK d STAIRS �441A�-7IEL7 EX15TiniG �/✓/F m r ' ' AA�uST - OV�iELL FIRST FLOOR EL -Sq.49 PROP. -7`X 10` •, -rIMOER DSC14, A$ovG r l I I ClNfl S\ T. P Eo / / I/ F_X\ST, t2'X3(oX4' R\VEWAy / / I LEACHING GALLE.YTU �,�t I ' (ZEMA11.1 11J SERVICE 1 Sewa,�,EPeRM\T 96-4bg Concrete Bound ®36.18 Site Plan NGVD 20.0 / Proposed Addition .. GV :- � 0` _ / - -- ' 1�o�1L-2�c.Qu p X/ for: Paula Sullivan PLAN VIEW POWERS Mo a at: 34 Power Drive Centerville ,I S DR/VE ti� 41 ,w ��' Sullivan Engineering Inc. 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