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HomeMy WebLinkAbout0007 PUTTER LANE - Health 1 Futter L dll e Centerville A = 247 — 127 nli UPC 125413 No. 5ROR HASTINGS, FIN TOWN OF BARNSTABLE LO%ATIQN 7 !b SEWAGE # VI LAGE. —- ASSESSOR'S MAP & LOT W�1-/a 7 ►r�s p�e�f�+s 13ISMAttER'S NAME& PHONE NO. r40-&-,VA-k XASPO-JLCI^,� o /� SEPTIC TANK CAPACITY A�00 6A //DitS LEACHING FACILITY: (type) 'IleACA.1 oleo �3J (size) AW 40W Le&4 1V" NO. OF BEDROOMS Z Bt}B-B OR OWNER -15-6S(K G&Jlk M PERMIT DATE: ' G@#4#WAVW--E DATE: 8 114A Z 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 o�hing facility) Feet Furnished by //�r1 �o✓� `/ S 1 3�clz d V40,ek i y � O �• 3 3 6 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION � 5 RECEIVED SEP 4 2002 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 7 Putters Lane Hyannisport I Owner's Name:Jessie Green Owner's Address: Same Date of Inspection:8/12/02 Name of Inspector: Timothy Lovell Company Name:Accurate Inspections Mailing Address:550 Willow Street " W.Yarmouth,MA. Telephone Number:508-771-3700 PARCEL CERTIFICATION STATEMENT LOT � �.._...�..�... 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: x_Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 8/12/02 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. 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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _x 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: _N/A 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. N/A 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 infiltration 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: _N/A 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: N/A 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: t � Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Putters Lane Hyannisport Owner.Jessie Green Date of Inspection: 8/12/02 C. Further Evaluation is Required by the Board of Health: _N/A 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(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: N/A Cesspool or privy is within 50 feet of surface water _N/A 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: _n/a 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. n/a_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _n/a 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 stem asses if the well water analysis,performed at a DEP certified laboratory,for coliform system P y >Pe ry, 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: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _x_Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _x_Liquid depth in cesspool is less than 6"below invert or available volume is less than V2 day flow —x_Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x�Any portion of the SAS,cesspool or privy is below high ground water elevation. _x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _x`Any portion of a cesspool or privy is within a Zone 1 of a public well. _x Any portion of a cesspool or privy is within 50 feet of a private water supply well. _x 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 CUR 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: N/A 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—f WPA)or a mapped Zone H 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No x_ _Pumping information was provided by the owner,occupant,or Board of Health _ _x Were any of the system components pumped out in the previous two weeks? _x !Has the system received normal flows in the previous two-week period? _x Have large volumes of water been introduced to the system recently or as part of this inspection? _x _Were as built plans of the system obtained and examined?(If they were not available note as N/A) _x —Was the facility or dwelling inspected for signs of sewage back up? x _Was the site inspected for signs of break out? _x _Were all system components,excluding the SAS,located on site? _x_ _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? x_ _Was the facility owner(and occupants if different from owner)provided with information on the proper tenance 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 _x _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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_2_Number of bedrooms(actual):_2_ DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_220 Number of current residents:_3 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):_n/a_ Seasonal use: (yes or no):yes_ Water meter readings,if available(last 2 years usage(gpd):Yr 2001(43000Ga1)Yr 2000(30000Gal) Sump pump(yes or no):_no_ Last date of occupancy: current COMMERCIAL/INDUSTRIAL n/a Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seatsJpersons/sgft,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:_Owner 10 yrs ago 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: 1994 Were sewage odors detected when arriving at the site(yes or no):_no_ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/1V02 BUILDING SEWER(locate on site plan) Depth below grade: 2 feet Materials of construction: cast iron _x_40 PVC_other(explain): Distance from private water supply well or suction line:_30' Comments(on condition of joints,venting,evidence of leakage,etc.): Joints look fine venting ok no evidence of leakage SEPTIC TANK:_z (locate on site plan) Depth below grade:—1' Material of construction:—x— — 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 Gal tank Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_3" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle:_14" How were dimensions determined: in the field tape measurements— Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Recommended pumping every 2 years,tees are in place liquid level is at invert out,no evidence of leakage, structurally the septic tank is ok GREASE TRAP:—n/a (locate on site plan) Depth below grade:— Material of construction: concrete metal fiberglass___polyethylene—other (Explain): — — — ___polyethyleneDimensions: 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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 TIGHT or HOLDING TANK:_n/a (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:_x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0"_ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No evidence of solid carry over Liquid level at invert out,no evidence of leakage.Box looks level PUMP CHAMBER:_n/a (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) ff SAS not located explain why: Type —x_Leaching pits,number:—I— 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.): Leaching pit is 31/2 ft deep below invert in x 10 wide liquid level is 41/2 ft below invert in cover is 18"deep no evidence that liquid level has been any higher,no evidence of hydraulic failure,vegetation normal. System has been used for seasonal use only once occupied year round system may function differently CESSPOOLS:—n/a (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:_n/a (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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 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. Rear of Home 41' 17' 23' 43' 48' 31' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Putters Lane Hyannisport Owner:Jessie Green Date of Inspection: 8/12/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_12+_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: Checked with local excavators,installers-(attach documentation) _x Accessed USGS database-explain: Plate 2 You must describe how you established the high ground water elevation: Information provided by Cape Cod Commission well Data TOWN OF BARNSTABLE LOCATION -7 Pyri-E^-S Ln7 , SEWAGE # jq- .31� VILLAGEV e 4jAr,,j jiS cvc!-%- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 6tUS 6itu; C�:.fir - fc�•-��.3'� SEPTIC TANK CAPACITY /v v LEACHING FACILITY:(type) 'I (size) f e� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Pulp--lc- BUILDER O OWNER ���N 1 c= r'''1 /q it, N DATE PERMIT ISSUED: 44 DATE COMPLIANCE ISSUED; t VARIANCE GRANTED: Yes No r� Ae 1'T Eot S N. ` 4 r3f4cr - f - f 3� f L•0 CATION S E W AAC E PERMIT NO. A o T/G ,Ow77e7 d 4.J. VILLAGE INSTALLER'S NAME i ADDRESS I iy to- GUILDER OR OWNER DATE PERMIT ISSUED 0ATE COMPLIANCE ISSUED f® �� 0 o ia' _, `i' f AI) THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1-,)''S !�TOWN OF BARNSTABLE Data Appliratinn for Uifipninl Works TnnitY) an inn amit Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal em at: Ln! �1 ------------------------ --- _.__ 7---- .. Lg . \d�ldres or Lot .........�,�!...... .... ... ......... .__-._ .............................. .......... ......_................................................................................. � Installer Address /� Type of Building Size Lot____________________________Sq. feet .. Dwelling—No. of Bedrooms------------ --------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...__________-_______----_ Showers ( ) — Cafeteria ( ) 44 Other fixtures -----------------------------------------------------------_-----------_.__-•----_- ---_._-----•-------•-•-••----•-•------•-------•-------------- W Design Flow............................................gallons per person per day. Total daily flow......__-_____-_______-eL...................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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................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.................... 9 ----•---•--------------------------•----•----------------....-------•-----------•-•-•--•-------.........--•-------..._.........--------....--------••--_..... 0 Description of Soil........................................................................................................................................................................ U •----•--•-•-•••-•-••----••--...-•-•-•-----...--•-----------•-----------------------•-----------•....----------•------------•-------------•---------.................................................... ---------------------------------------------------------------------------------------••----------•............................................................. 0 Nature of Repairs or Alterations,—Answer wh ntapplicable.- _-. �- _... P. �'---- - -----�t --•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental C9,de—The undersigned further agrees not to place the system in operation until a Certificate of Corn fiance h een issued by t o r of health. Signed _ ......_. ' Application Approved By ------------ ! J..�.�c...". ..�,.'. ... ..................... .......................................... .......1..-..a�..4—..-..9�/ Date Application Disapproved for the following reasons: .... . ........................................................... .................... ...........I.................. ..................... ................................................ . ......................... ................................................._.. .... .............. -------- *......... -------*........... Date PermitNo. ..........T(4....'........�� Issued ........................................... ...................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifirate of Graplianre THIS IS ZD CC RTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired b -=--.G-I...S------ lD. S 7�' —y .................... f). I., .... ..�� � /. Dz ................................ . has been installed in accordance with the provisions of TITLE 5 of/The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....'3.6 ....... dated -------................................... _. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...........��.........._...•��..............�.. .:... ..._--------........------ Inspector,._..w- _.... ............................... --------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...l..y --� . FEE....?J............ Disposal Works Tonstrodton rrnnif Permissionis hereby granted---------------------------- -------------------•------------------------•-•-•...-------••------------------••-•-•--•......---........_.-•--- to Construct ( ) or Repair (114 an Individual Sewage Disposal System at No. ��d �J :''fir '�7:1f11A1,A11-4A S .A--- -------------------------------------------------- ; �_....�_. St as shown on the application for Disposal Works Constructiormit No. y... am.-- Dated..- -. 4 �. ........... , - ------- - - ------ Board of Hcalth DATE.............I . ...Z... ..' ................................ FORM 38608 HOBBS 6 WARREN.INC..PUBLISHERS • _ 1'. ` THE COMMONWEALTH OF MASSACHUSETTS Er BOARD OF - HEALTH S�TOWN OF BARNSTABLE Appliration for Di►ipoottl World, Tonotrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (/an Individual Sewage Disposal Sy tern at: �✓ L it Addrrs� or Lot No. o a i --- --- ------------------ •----•---•--..................------------• a �---� Oo ner.: s � ,�1/L��, �� � Installer Address Type of Building � _. ___ •s , Size Lot............................Sq. feet II ,., Dwelling—No. of Bedrooms.__..._.___.4 ____________________ sion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ................................................. d -------------------------------------------------------- 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 ( ) 0-� Percolation Test Results Performed by-------- --•--•---•-------------••--••-•...-•----..__...-----•------------ Date........................................ 0.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to groundwater........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil..............................................................................................................................-------------------------------------------------------------------------------------------------------- ....... _. . U Nature of Repairs or Alterations—Answer whenpplicable.. ../r!% C .___ _..._. . _ Ja_____.._.. '��_. '. � 1_ ✓' ----•- ..................................................... .._..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com liance h een issued by t 'oard of health. Signed .. .!/ .... �`"' ................ ......... ...................................... Application Approved By ............ . .. .. -' _ .... ................................................................... .......J....-.. .. 1..-..95f Dare Application Disapproved for the following reafons: .............' ................... . . . ....... .................. ... ........................................ ....' ....................................................................................................................................................................................................... ....................................... Dare PermitNo. ..........7..u....'...3C......_................... _ Issued ...... ........................................................... Date ............................ THE COMMONWEALTH OF MASSACHUSETT; BOARD OF HEALTH Application is hereby made for'a Permit to Construct (ZT__0r Repair an Individual Sewage Disposal System at: Location-Address or Lot No. I Installer Address Type of Building Size Lot...1.52;;� ....Sq. feet Diameter../_O_'� ..... Depth below inlet..&4........ Total leaching area.,,SrS-C1...sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed ................. Date2__Z-P� �4 Test Pit No. I....A4!�.minutes per inch Depth of Test Depth to ground water ------------ Test Pit.No. 2-----2!5�inutes per inch Depth of Test Pit... Depth to ground water---- ---------------------------- ------` `----'`-------'-----`---------`--`------- Agrceozeur: No...r1q ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ..........OF...- ---- - ----- -------I Appliration for Uiiivaaal Works Tomitr-union Prrutit Application is hereby made for a Permit to Construct or Repair Repair an Individual Sewage Disposal System at: /r-U 7;7-2: ............... .......................................... .................................................................................................. - Location-Address 17401eemc>......................... ... O;O...C..7...r .. o........... 0 No. Address ....... . . . ................... ....... .............................. ................ Pq Installer Address Type of Building 3Size Lot..Z:�2 S'il. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons......_____..............__. Showers Cafeteria Otherfixtures ......................................................................... Design Flow..........._5_5 ....................gallons per person per day. Total dailX flow...... .....................gallons. W F 1:4 Septic Tank—Liquid capacity/ gallons Length_k........... Width.../......... Diameter................ Depth.. Disposal Trench—No. .................... Width...._....._..__..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..../............ Diameter../O........ Depth below inlet..CP.............. Total leaching area.. �...sq. f t. Z Other Distribution box Dosing tank Percolation Test Results Performed by...P&777,"-Z... ................ ..........Date.-2Z__�_/ 7- Test Pit No. I....A7!n.minutes per inch .Depth of Test Pit...ZY....... Depth to ground water...._. 44 Test Pit No. 2..... '_!':minutes per inch Depth of Test Pit__-. Depth to ground water_-__. R'i " ";�............................................................................................................ ............................ 0 Description of Soil.. ........j;;�........ t .. .... W ........... ... ........................ .......:2_.( ...................... U ...... ........S.'q� .. ............. ........ ........................................................... W .............................................................................................................................................................................. ......................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ........................ ..........*------------------------ ------------------------­---------------------------------------------------------------------*-------------------------"--------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance h�ieefi-i—ssu3g by the and alth. Signed) . .......................... D -2 ............ .... ...... ..................................... ... Application Approved By..... - 4 .W Date Application Disapproved for the following reasons:....................................................................................... .................. .................................................................................................... .................................................................................................... Date PermitNo......................................................... Issue&....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................OF... ....................... Tutifiratr of Toutphatta THIS IS TO .CERTIFY, That the Individual Sewage Disposal System constructed ( Repaired by.......L)A.............fi� -, ....I .......................................................................................................... Installer A J at ...............................I................... .......................................... . ................................................................................. has been installed in accordance with the provisions of TITIZ 5 of The State Sanitary Code as described in the C.- application for Disposal Works Construction Permit No.....q.. ............ dated................................. .............. THE ISSU.�Apfclg OF THIS CERTIFICATE SHALL NOT BE CONSTR E AS A GUARANTEE THAT THE SYSTEM WILL TI N-S-ATISFACTORY. DATE....... ................................................................ Inspector........ .... .... ... .................................................. THE COMMONWEALTH TS OF MASS./CtHUSETTS BOARD OF HEALTH OF No... F E E..1.7 .............. Disposal Works Tomitrurtion pamit Permission is hereby granted....-4D/4n,)...........0 to Construct C "i Repair ( -) an Individual Sewage DISPOSal.System ............................................... -- ---------------------------------------------------------------------- ................. Street as shown on the application for Disposal Works Construction Permit No..................... Dated..___.___..._........................_.... ...................................................... Board of Health DATE............................................................................... FORM 1255 HOBBS & WARRIcN. INC., PUBLISHERS .rl LO•CAITION SEWAGE PERMIT N0. �u T' VI tLACE ' INSTA LLER'S NAME,' & ADDRESS Doy 82 01d Sta99 Read B U I'L D E R OR OWN ER ;,' .�'i 0��i2'T �/�z1/�/r'��'/1• /.�iy'i�r�.��e.S�i�ir� DATE PERMIT ISSUED 1�-25— DATE COMPLIANCE ISSU ED. � ,� e /.. y.. !,� � .. i �`a •i L, b -� f �� W1 ��� � i � ���P � `9� � W ,, � �� ,t 4 r�\\\ � ,. z or '7 - - ° A i . No...._.....2.T9.. - Fizs...2. .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 10.W..N...............OF.......FhX.. .S.TX Appliration for DiipnsFal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ..�..L1_Z_T,eOR.. Cs.!_:...11kA,#19_llld f?PR�:...... ........./aT-.......�7•-----------•-------------•-----------__-_______---------_____-- Location-Address or Lot No. 02............................................... ..........E►.i:T E2 V 1 Ie�C_.......... ........ Owner Address a i o2.i fJC � �t�•............................................. -----._-_'3C IJ5•i• Ai3�E -....--------•-•-••••.........••_..._. Installer Address Type of Building Size Lot_;;Z54-11$.....Sq. feet Dwelling—No. of Bedrooms..........._.:T..............._..........Expansion Attic (No) Garbage Grinder (N()) aOther—Type of Building __AA.JIA_____________ No.=of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures --------•------------------------•-- .........................................................-..-•-•---------------------------------------•- �W ReDesign Flow_-_-._/�Q___________________________gallon n cpa;e day. Total daily flow--------.2:3n...................gullons. WSeptic Tank—Liquid'capacity/Q.O _gallons Length_&__-6_____ Width.4_20_='.. Diameter________________ Depth__.�`'____�.._. x Disposal Trench—No. .....i.............. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./---------- Diameter__/.A._'_.______ Depth below inlet_3.t..$........ Total leaching area._/1C7.....sq. ft. Z Other Distribution box 00< Dosing tank ( ) Percolation Test Results Performed by..WON,r94D.*._s9--<Fzfmpp..,.-t'".s._-_..._. Date__/.VAV&c&1.4 ._ F' Test Pit No. 1_.sty -__minutes per inch Depth of Test Pit....6...-_____. Depth to ground water__<9..I_____________ rX4 Test Pit No. 2-_�A'2-._minutes per inch Depth of Test Pit___ ____________ Depth to ground water-................. a ------ ------•--------•----------•-••----------------------------•• --------.......---....••--•-.....•--•-•-•••------•---•---••------......•••-.......•---- O Description of Soil-- �^ Q/_��---/_Q!-JD.....------�1/. ��C ---------------=.--5z tr' - �r.��1' Z?1.fAw V �0il.�_Z>--------------•-----._._.._-..--.---•---•------•---._...-----•---------•-••----•-----•------....-•-----------•-------•-•-----•---•-------------..-...._..._.-..------------•. W ---------------51�!��...........S.�f� CQAJ.�•Tlj9M.S.......fu_-3.07 ...... ns,;r �04LEs..................... UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..........-............................................................................................................................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si- ,�..... ed ---------------------- •-•------•-------- ---- Date Application Approved By...... .. . ...... Q�f ,'� —7 Date Application Disapproved for the following reasons: -----------•---------------- ----------------------•- ­7 Date Permit No............ •-- Issued..... ..........1% .......... Date - - NO._-------R21 ..7?__ ^ �. Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH " %O W N __...............OF.....- 44 A/57 �. Appliratiou for Uhipoli al Works Tomitrur#inn Prrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual t Sewage Disposal S stem at* +yam l�--/-"f2 .............................................' . �. ". • '�, Location-Address o Lot No. Nola� (ZT 02t�C2 . ;z" , Owner Address w U L. i o�p ►•PJQ•-.. :p`?- ----------------------------------------•-- ••-= is 1 .;.: ?1=, . a Installer Address `+. Type of Building Size Lot_............................. Sq. feet a Dwelling—No. of BedroomsA.T'4________________________________Expansion Attic ( ) Garbage Grinder No) p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Ot�� tures :_ j ,bd�rc+rrNq ----------• --•- ••---- Design Flow_____ ____________________ __gallons per perso per y Total d ll , ow____._. ' ______._.___ gn s> W Septic Tank—Liquid'capacit}� Q _gallons Length._ �� _ Width � . Diameter______ _________ Depth_ t'3__.. x Disposal Trench—N ..................... Width___.00______________ Total Length...3.___S....... Total leaching area.... ..__.__._____sq. ft. Seepage Pit No.............. Diameter..! .`. Diameter._/ +-.._______ Depth below inlet.....'............. Total leaching area_ ¢_.___sq. ft. Other Distribution box l ) Dosi tank ( " ) Z Percolation Test Resul s Performed by- -C�4!19l>�?._.'4' 611f�kZ?, 'S'___.____ Date_M11Rce 9 /r;V �a __minutes per inch Depth of Test Prt.____ �__.__._. Depth to ground water.. .............. Test Pit No. 1________ __ P P p fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water.4 ................. __...----•--•------.. .... _.. �. Ca li � f/ ► Descr ti n o Soil ---•.................... ....••••...-- --_-•--- ,. U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------_................................... -------------------------------------------------------------------•------------------.......-•-•-------•-----------------------------------------------------......................................... Agreement: The undersigned agrees to install'the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. n ----•-••----•-------------•..._..--•-••......•_••-• _.. Da Application Approved By---�� ._..:.. "1'" .......... ._..... ` ... �'r ...... Application Disapproved for the following reasons:........................ ......................i......................................... Date.............. .............................................................. ......................................................................................................................................... Date PermitNo......................................................... Issued-..................................................... a Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ...................oF....� Z ........ .-.- .•.p Trrtifiratr of f��autpl anir TIJIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed .( ) or Repaired ( ) by------ C �cC l AJ O__--b 2 •-------•----•---------------------- _ Installer at........ c� -7- PUTT C r.•---• iNi IJL has been installed in accordance with the provisions of _�E 5 of The State Sanitary Code as described in the y. application for Disposal Works Construction Permit No............ __7_. ............... dated. ........... THE ISSUAN OF THIS CERTIFICATE SHALL NOT BE CONSTR�IfE® AS A GUARANTEE THAT THE SYSTEM WIL U TIO S TISFAC ORY... Inspector___ ________________DATE............................••---- :. ._..----- •---......-- - -----•- ,.,... -------------------._........................................ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALT14 ., a . ...............OF.. 1e T�ll LE.... _......._.....--------•••......_.. No......................... • FEE ............... Permission i hereby granted_._ -_i_o_+S')0' _..__ to Construct e ) or e5ir L _) an Individual Sewage Disposal System at No I. r u I I C l2 L�-)01r. . VJ. E••4-Y �-N i� P0Q-1 -----------------•--•-••--------- ._......................•-•••- ---�----------------- .................................. Street M as shown on the application for Disposal Works Construction Zit�No ___ Dated ���.._�........................ ..--...--.-_- --------------­--;_ Board of Aeal DATE--............................................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS `' . t•• r c, i j fly M,'.s „ { j l' 44 4��Tri �! fi w µ ,. dr y ¢ l /n/E `--� Q9 •�u'�st t: 11 - f � ', ' - La•T �, , .ASS'UM 1? • ..r.-I ��7�''� N at ! .3 l A - .. F �C. VV V,D X F �D.I VO 11, - ' 1' loft, { 1-_'S�71 Y 1. 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