The URL can be used to link to this page

Home My WebLink About0157 PRINCE HINCKLEY ROAD - Health 157 Prince Hinckley Road Centerville P r A = 172. 198 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 157 Prince Hinckley Road Centerville, MA 02632 RECEIVED Owner's Name: Jane Allen Owner's Address: Same APR 17 2002 Date of Inspection: April 8, 2002 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 172 Osterville,MA 02655-0049 Parcel: 198 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Needs Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: April 10, 2002 The system inspector shall su i 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal'or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 f - Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTION FORM PART A CERTIFICATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 D. System Failure Criteria applicable to all systems: You must indicate either`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 '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 No. Fee e THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSAC USETTS Application for Dtgpoga[ *pgtem Con5tructton Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7 s— Type of Building: Dwelling No.of Bedrooms �, Garbage GrinderQ1 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Adel�l_6dJ f'- NntA C C X � t.2G.Ck Pt� -(.I I0 9 k t� S�C �R• ��r1��Q�Set 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 Env' ode and not to place the system in operation until a Certifi- cate of Compliance has been i d by this 13oardo / Signed y �- Date / � (r? Application Approved by Application Disapproved for the fo owing asons Permit No. ��' 1 !J $ Date Issued No. 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSAC USETTS ZIpplication for Miqooal *pAcm Cong4ruction Permit Application is hereby made for a Permit to Construct or Repair an On-site Sewage Disposal System at: Location Address or Lot No. L_61 1 Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. CNN\- Type of Building: Dwelling No. of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers Cafeteria( Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) AdA ftJ61 ekn-f^ I CX C. CjeaC�, P,j C—A-1 D 9 k V,C!.R !7—\ M (Use 5 ]c _�C, 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 Eayjjj:�al-Code and not to place the system in operation until a Certifi- cate of Compliance has been is,14�dby this]Doainmta4�� Signed o )Ak Date �0/0?1/�Pr Application Approved by Application Disapproved for the fallowing asons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System in talled or re aired/replaced on by C-tup,� for < -) ,._ -,r,.V U -(A-&,� has been constructed in accordance with the provisions of Title 5 and the for Dispo4al System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth b low: No. 1 96 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS lwi!5posml *p6tem Con5truttion Permit Permission is hereby granted o ";Cc,�A (V\ to construct an On-site Sewage System located at _C (nvCk e 4 2 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. All construction must be completed within two years of the date below. Date: Approved by s OM1lic"I�QUUM "0 GA�Af 1a c-'Rrl.tv�JZ _ __ r&l l_�( F=L�.V a 11b +� • sso C. PD• 4 �vo cao _•_... Ur,e- t Cod 6At_. rlSPos,ru. PIT tso SF Z.S + V75 d(P 'BtrT', loAA TcUTaL 'flESlletJ s�'z�j G..P.D. Z 1-6TA t_ v6c'ecc>LAT10LJ' RATES 1"IIJ SAAIW• OR 14 t GNDE� CO SAX -44 t4i $ i r '?o.og PAO, , 1 'TEST Il 23/77 4. Sa►?�c��. Q'�Pls MKT IW 6s•.. �'1 �. 2, / -sox 4G d sepric (C T_:�_ MV. / TANK , i GoA�c o00 5 w. 7 LancN s' x ' r` •, , STo�•JEs 89.g .• ... C- aCTtFi�xtp AV I'L u o Sc A Lam- I� au.J iQ r � ely.IL•t'1 F�{ T 1-(A T T t-1 G. r:>V-.''.L)A1�pU 'S 1-Ie�I•/W r.. ^'...a...��..*.. ►��.... t-l�.�tr�IJ GclP�`�S WIT" T►J _ 51D�.1.i►-lE hJ ,, 56? AWL> ->L- L� Y ,nctG v cq U I W G AA c 1 T-1, OP T N �aww cF `�tlt� �1'iTAt?,�'•� r C��t�t��tt.�:¢�, 1�a4r��a+�s' •� ' > RC G l S tttZ�D LA N Cj 5u e.v�Yd.1z�+' TI-�15 Dl_A►J t UUT 01-.I ;w,rc.'.�i.,n�-•�� ,��c.�i• -,� ;� T�a�: c�t=�,r_r�, �;Ii�wW n►,I�t_tr:A.►�_ I•'<:,r CCw. U=,LC'> Tir lir�l �k_Arl•�-Jl:.- l_U"r l_Il.li_�� 'AL �_.. Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on'a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2001 - 105,000 gals.; 2000-59,000,gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped on Jan. 2101, Dec. 6197, Dec. 20195&Aug. 7195-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: New pit added in 1996 Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Approx. 32" Materials of construction: _cast iron ✓ 40 PVC _other(explain): Distance from:private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 Qal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8. 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must beiopened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs of solids PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 r Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 157 Prince Hinckley Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(new pit has 2'stone-per as built card) leaching chambers,number: leaching galleries,,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): The new pit had 6"of water on the bottom The scum line was at the same level There were no signs of failure The old pit was dry. The bottom of both pits to grade was approximately 8'6" CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 157 Prince Hincklev Road Centerville, MA Owner: Jane Allen Date of Inspection: April 8, 2002 Map: 172 Parcel: 198 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Aa- sc� �g ga- a? A3- (o (33- 3S 1 S oLj4 y o q I 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 157 Prince Hinckley Road Centerville, AM Owner: Jane Allen Date of Inspection: April 8, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water ' 25' +/- feet Please indicate (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 8'6" Usina the Barnstable topoaraphic map and the Cape Cod Commission water contours map, the maps were showing approximately 25'+/-to around water at this site This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION l SEWAGE # s" VII.LAGE G� n:,Il,� ASS SSOR'S MAP & LOT 0) INSTALLER'S NAME& PHONE NO. SEPTIC TANK CAPACITY I t'JITb lew one, a ' sro� LEACHING FACILITY: (type) P, T—.S (size) NO. OF BEDROOMS 3 BUILDER OR OWNER �✓�✓� /a `�� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching.Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachinAli cility) 1 Feet Furnished by T SSGUri � rI r ga- a? A 1A3, (° i i33, Ay, La fay. 51 3 (35' yy S vL�d y n cW TOWN OF BARNSTABLE LOCATION 1� 7 �� (�CC.Q �1�� / SEWAGE# VILLAGE IKJLV � " ASSESSOR'S MAP & LOT/ INSTALLER'S NAME&PHONE NO. , ® SEPTIC TANK CAPACITY Y: ( p�)LEA DAfL 0(O®x�co (size) CJ QNO.OF BEDROOMS BUILDER OR OWNER _ )-%CA j PERMITDATE: tZ 1,30 ( .COMPLIANCE DATE:j Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility1nQ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) NR Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ql/�, -� f CD -3 �Id M+ Bb 4 � Q- , old C�� LOCAT10 �s� SEWAGE PERMIT NO. -LOr. 86 Prince Hinckley Rd. 78-381 VILLAGE Centerville I N S T A LLER'S NAME - i ADDRESS Alfred Fuller Cotuit Road Marstons Mills, MA. BUILDER OR OWNER Alan E. Small, Inc. Box 536 Centerville, MA. DATE PERMIT ISSUED = 7-19-78 DATE COMPLIANCE ISSUED ` - � a � , . � ,�`� � � � � ��q� �� .__ � __� No.. J Fimu........... S'............... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE TH - --------OF..... .:�..... t!.� ........... ............................ Appliratiun -fur J iVaii l Workii Tunutrnrtiun Vrrutit Application is hereby`made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal . Sy e" n a �'C� �2�--- �L ati. •Address04 p orsL��t - �G'' ► ---• •-------•• . ------... r �!'`'� l ................... ............ -- .• ---- -----•---•--------------- Wz e � Address r -•..-----•--•-•----------•-----•- ........_•• Installer Address Q Type of Bu`ildin Size Lot............................Sq. fee Dwelling No. of Bedrooms____.... __________________Expansion Attic ( ) Garbage Grinder • aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ) Q' Other fix res . W Design Flow. ............. ...... _.______ allons per person per day. Total daily flow---� �......._.:......_..:.gallons. WSeptic Tunkr Liquid capacity' ___gallons Length,_______________ Width.......__...__. Diameter-----...__.----- Deptll................ x Disposal Trenc>h--- __________________ Width._ � _______ Total Length----------- � Total leaching area------------.-------sq. ft. 3 Seepage Pit No...�______________ Diameter--------- __ Depth below inlet-------&er_....... Total leaching ft. Z Other Distribution box ( ) Dosin tank 11123177 Percolation Test Resul s Performed by.__ _ ..�-(, ........... Date............. • - aTest Pit No. 1.. __minutes per inch Depth f I est Pit____________________ Depth to ground water...._._____.___.__._.... Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__.__._..__-.________._. O ---------V _ d- _ Description o joil-----Q. -I _ < .� x 1--...---�-. - . A14L-:O/------------------------ U UNature of Repairs or Alterations—Answer when applicable......_________________________________________________________________________________________ -----------------------------•---------------------------------•--------•---•-------------------'------------•---•••--------•----•••------•----- -----------•------------•----------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage D1 osal System in accordance with the provisions of Article NI of the State Sanitary. Code—The undersigned fur t}jer agrees not to place the system in operation until a Certificate of Compliance has been ',,s'I". ,y the bo t 4heif a. Signy.._ .- ... �! ....................... ... Date Application Approved By----- ---- - ---- - ate Application Disapproved for the following reaso ns:----------------------------------- ----•---------------•---•------•-•--•-•-----•-----------•------------------- 4` .............. 9 Date Permit No............................................. --- -------- ----•--- --------• ......... Issued------y��" 1 Date + l —-------------------------------------------------------------------------------- --------- THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No.------..:1° ..... ... Ficiz......:.... ............... LTH THE BOARD A0F FHEALTH Ts ..................OF..... ....}.!` ........... 9-r.,.- .... �✓ Appliratiott -fur Diupuuttl Workii Tottutrurtiott Vrrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System.at.:,,e: .... '- - --------------•---- Location-Address / or-Lot No./ t e/....1 .{ a �-7-s ✓ L.— ( ..��✓'�G+. i +!/Y./. ;. . W / Owner / r� �f )Address = -•--•----•-.•------•--•--•--•----•-•---•-----•••......-----•--------•••... Installer Address U Type of B ldi g Size Lot___________________________Sq. feet Dwelling—No. of Bedrooms.--_--__-.:_-4-----------------------------Expansion Attic ( ) Garbage Grinder (+ ,}.,`.•* < aOther—Type of Building ............................ No. of persons...._--_.._-__-_-_-----__-__ Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------- W Design Flow. ..............ra�'.-__...t....___.._.....gallons per person per day. Total daily flow...._<=!^L- ............................6gallons. Septic T..nk—Liquid capacity --- _!gallons Length---------------- Width................ Diameter---------....... Depth-.---------.--.- W Disposal Trench—No. .................... Width__--------------- Total Length-------------------- Total leaching area_..----------.......Sq. ft. �. Seepage Pit No____I_______________ Diameter---------- Depth below inlet------ ........ Total leaching area_.;:,: ,'4__'.__sq. ft. Z Other Distribution box ( ) Dosing tank `-' Percolation Test Results Performed by _:' < } - +__-. ` F a -- ------------ ._..---- Date--- ......... ~ ;Test Pit No. 1___: `----_minutes per inch Depth of "Pest Pit .................. Depth to ground water------------._--_----- Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri s ` Description of Soil. ' ,� F+ - -------- ! ---------------------------------- Ur ---- ----------------_ --- ----- --- Wr x ......................... ---------------------------------------------------------- ----------------------------- U Nature of Repairs or Alterations—Answer when_applicable.__-----------------------------------------------------------------___________________________. ------------------------------- ----- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article tI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been jissued'by the board of health. Signed €' --:_f:---.--' -.--� .-J .{ _ f Application Approved B � , .�" Date f'PP. Y , n Date Application Disapproved for the following reasons:-------------------------------•------------•----------------------.------------------------------------------- ----•---•-------•--• ----------------------------------------------•------------------------------------_-•-------------------•-------------••------------------------------- -------------•---_----- Date Permit No.......................................................... Issued.._77�11 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Cnrrtifirate of Tampliattrr THI I C��tTIF , That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by--------- ----------------------------- ----------------- --- ••-•-••-••--••. ----•-••------•--•--- r 40 �... has been fnst lied m accordance with the provisions o Th ate Sanitary ode As desciibbed m the application for Disposal Works Construction Permit N e-f-_�_e.,---.-_--- dated. _�_�^__.��'" !� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WJ L FUNCTION SATISFACTORY. DATE- -- 2�If --`-----._'.- ------------------------------------- Inspector---- --------------•-•------------•---------------- THE COMMONWEALTH OF MASSACHUSETTS ` BOARD F HEALTH ...........*.....................O F....:. � No......................... FEE-------.• Binpuuttl Murk n ,trurtion Verutit Permission 's .eby granted_________ -------------- • to Cons r epair ( an Indivi D dua ewage • al System at No... lorl..... ��s...... ---- 1 - --------------------------- S et as shown on the application for Disposal Works Construction Permit No.............. ..,_/Dated-_-.-�-�--..t-74.____.._.. --------------------------------------- C..- - / Board of Health DATE '' "". : �'---------------------------------------- • FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . r +A(_'1,.45,t -!ems ->reI % 33U G.P.D. (c5o % _ •4qr,,6.Pt�. tvo cam 1 u s4C-- t C . (Dorn (G4LL.. sc"wAu. t-E.a. Aso s.F. I tc SI= ,c Z.S + 3 75 G ap II �/I/� Q.Q�i r � ►�.T. � r� p"�. �T. U TaTh tr ` >eSl& I T'°'.t 4 !l� 4 EftGDt QTtO�.I tZI�TE 1��r►J I-M i►J otz 1Y--55. $� /4 t r,Nbee CvAler 'r'f' - — �"' r� Il it �¢-'a f ..r 1 i IL iAr. Ley o�v. I il�/_�� Tor h41Q f// t ICy O.Q RJR* t e"J�.wi tf ppB DOO tbN 'A S��SVIt, 4'yP4 D y�r'T IW. 6A.t., 4G i 1 -box % 5c- TIC , IWV. CoA rG 100O �� 1w. , GAi-. PrT •� C�2tLllt$:iL. 4� - WIT1.� .y C STONE 84�Q L oe-AT 1 O" "5 I•L' ►.a o s A.Lc-- VIJXTWL T r-Wr T r4 C-- T�V Qr,>AT C94 S Naw►.► t-1�`.t:t�rat.3 Gc�t.l PL�(S W r'C't-i Tt-•1�:; 5►��.1..1►-1E: T , A u t> -3e T L,h C K k' Q r itM uTs o Y ►�tom. T SG �C.. .. 0� P�. 2 `tawW GF �f�l2 j'1'QI„ilw.+L3 t.tU1'a•thLt.& �16t4tA14 # rZC G 1,5 rt---aGr> i-A,1»t j 5u cv a,(o k.-. h o ,I�•�r��:. .rr� w; �,c .il �r KT1aG l.�lw�.;r_tj, �x�-�v:..c..�:� n.F��a�..lc_�.►-� `r' I.. ,r c,c: u=��::c� TiO .1>r 1'i��hic►Jly� t`c�r �_r�a� : _ _.� _ ALAQ rv�au--�:_.. ._