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Home My WebLink About0019 TARAMAC ROAD - Health 19 Taramac Road Centerville A= 1.69 - 107 S M EAe Na Z45MR UPC 12834 snm cm • Made is USA A imb, a� ■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Taramac Road '- Property Address Muriel Thomas Owner Owner's Name information is t/ I;J'I required for every Centerville MA 02632 8/26/2015 ; page. City/Town State Zip Code Date of Inspection 1�a 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 67 on the computer, (� use only the tab 1. Inspector: key to move your cursor-do not games Ford use the return Name of Inspector key. Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S 12482 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 ❑ Needs Further E aluation by the Local Approving Authority 8/28/15 Inspect s Signature Date The st m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage DiR. Saystem-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. 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): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •r 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) ❑ 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): �I ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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 septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/Z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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 portion of.cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 !i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information.in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage unavailable 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currently Date Commercial/Industrial Flow 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 ❑ 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . r 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumped in 2013-per owner Was system pumped as part 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 system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 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 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed - 1983 another pit added later 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 joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 12" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal. Sludge depth: 2 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 25 Scum thickness 5 Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 12 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 cement tees were present. no sign of leakage. recommend pumping every 3 years or earlier depending on the use. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 - 1000 gal. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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 first pit was full up to the outlet pipe. The cover was to grade. The overflow pit had 6"of water on the bottom. The scum line was 1' up from the bottom. The cover was 1' below.There was no sign of failure. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 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: ® hand-sketch in the area below ❑ drawing attached separately QA � a � B 3 0 3 I � 31 y 3a a� r 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 ` Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�a a 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+1- feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: To o and water contours map P ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage bisposal System•Page 16 of 17 f Commonwealth of Massachusetts v W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a r 19 Taramac Road Property Address Muriel Thomas Owner Owner's Name information is required for every Centerville MA 02632 8/26/2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file !Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. �� "" Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Atlphration for Di5po5aY *V5tem Cow5truction Permit Application for a Permit to Construct( ) Repair(X Upgrade( Abandon( ❑ Complete System ❑Individual Components Location Address or Lot No. 'j I s ame ddre and el No. Assessor's Map/parcel Installer's Name,Add z? dam, No. �i,/ls Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of R pairs or Alterations(Answer when applicable) 4--n�� Date last inspected: Agreement: The undersigned agrees to ens a the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of tle 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t s��arof�, aSignedDate 111- �� Application Approved by m Date Application Disapproved by: Date for the following reasons Permit No. 4 Date Issued t No. '-�� Fee h2Q + THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MAS§ACHUSETTS Yes ZIPPrication for Bi5po5ar 41p5tem Cott.5tructfon Permit Application fora Permit to Construct( ) Repair(� Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 'P 6' MCI a an s ame ddres d Tel NoAssessor's Map/Parcel _ f4• Installer's Name,Addre and T4 No. /,ems Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 1 / nd Nature of Repairs or Alterations(Answer when applicable) L� 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 provi*- ard Environmental Code and not to place the system in operation until a Certificate of Compliance has been issuSig �m /� DateApplication Approved byi17�'(il�A/,�i(f Date Application Disapproved by: Date fo the following reasons Permit No. Date Issued ——————————————————————— J THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On- ite Sewagepisposal ystem Constructed ( ) Repaired (X Upgraded ( ) Abandoned( )by, !I' at ,, / / J 1 has been construct d-n accordance /�y,� 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 wi�ffiiftndje)igned. Date 1 �/ 1 Inspector- -------------------------------------------- No. Fee Z22 THE COMMONWEALTH OF MASSACHUSETTS "4 PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS / i IO � �I Ogar gte�t�� ,�p rrY Con6tructton Permit Permission is hereby 1jed to Construct ( ) Repair ( Upgrade ) ndoZ961Z/ ) 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: Constilctionjust bcompleted within three years of the date of t Date Approved by L O C A T I' a� � / SEWAGE PERMIT Z NO. VILLAGE A - Qetj I N S T A LLER'S NAIAE & ADDRESS d Mee I U I L D E R OR OWNER DATE PERMIT ISSUED F3 OAT COMPLIANCE ISSUED +t ' r i�I s a`� � �►l� ink ��.� 33 j Pr�- � � 3f � r_ . 0 o �� W 3 aa � J; 33 t 3 tL / ae Ll ,I ��Te h��.S �.�C�e, v 5 .�l�s�� C��rs:5 l�� c�� - II(( •�• --_ II .,y` T,-,'JI. CCovc BRUCE MACALLISTER SHORELINE CONSTRUCTION 87 POND STREET OSTERVILLE, MA 02655 No. _3�. 41 ..v FEs. .... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ....................O F..........................---...........-----................------....................... Appliration for Uiopoottl Worko Tonitrnrtion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Q a y a 11 �J C'h I t r� �..1....... . ............ ... .. .�1 ._._....--.........._...-.--....._.__.....-....._...... ................ cation- ress or Lot No. .......... l..j!».U..Y..1 ...... .N..O..2n.As........................ ..............................................•-----..................................•........... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) ................... d Other fixtures ----------------gallons per person--------•--------•-------•----------------...-•--•--------•---------.......---...........------------ W Design Flow........................... g P P 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 ( ) Percolation Test Results Performed by..........................J................:.....----•--•---•............ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--.--................. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GG 0 Description of Soil........................................................................................................................................................................ U ---------------•--......---------------..............----------•---....--•---...-•----------•---------.......--------------------------••--•-- ......................................................... W x •-• ••-----•................•-----......•-•-•-•---•------• --•----•---•-•-•-••-•-••--•.......•-••----••••-•-••••--•----------••-----•-•----•-•-•-•-•-•••-•-•-•-----•-----•-............•............... U Nature of Repairs or Alterations—Anwer whenj 1' .......... --------------------•-----.....------•-----.....--•--•............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIIi U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. / nedl�..P _.....r 11---•�n----••--- . ....... --------------- Application Approved By------- ------------- Z. _ ., Date ............. Application Disapproved th following reasons:.......................................................•------•---------......------------ ••--••-•--•-....... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued.......................--•------....................... Date o No.14._�a.......f....... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ....................OF........................... ............................ AVVfirtttiun for Uiiipuiitt1 Works Tontrnr#inn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* s �, t. ... III C4 p f L cation-.Address or Lot No. _........__.j ,�.11.. _t. °.�,..... ..E..G.. r..E1. ........................ ...... ...-•----------••----•-----....•-•.................... Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of 'Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0, Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ 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 PResults Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R: ----•-•_-- -••-••-••••-•-•----•-•-••---•-•-------------------•••--...--•-------•••••-•-•••.........---••-.................---•-•---•••---•--..........-- 0 Description of Soil........................................................................................................................................................................ We ................................................. --------------_ _____a__.._.______...___.._.._.......___.._..____.__.___._...___........ ___......__..........______________...___............____............__ ___.__.._..________.__....._._. V Nature of Repairs or Alterations— n5wer when,a- �11�ca Agreement: The undersigned agrees to install the aforedescrilTed. Individual Sewage Disposal System in accordance with the provisions of A ITIL- 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. l vd ......_ Ir. .......e Application Approved By-•-•--. ..._......:f._.:. ..._:, ..._ *� Application Disapproved the ollowing reasons:................................................................ ---•-•---•-•-•.........--•...............................•--•---------•--•••••--------•......•------••••- •------•_.-••---•-------------------•••-••-------------•_.._._......---.......-•-.•_.._. Date PermitNo.......................................................... Issued----------------•-------................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF . ... ............... .................................... (Inrtifiratr of. Tintphattrle THIS„I T 'CERTIFY, That the+Individual Sewage, Dis osal System constructed ( ) or Repaired by.........��,��f f �....... /.. a-•--- -----------------------•---•---•---•---------------------..---------------•---•-------•-•- �- / I has been installed in accordance with the provisions of TI 5 of Tjie State Sanitary Code descr' in the application for Disposal Works Construction Permit No----- _._.1'__ _f_. ,-_.._... dated......jam._ ........1� ................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE SYSTEM WIL FU CTION SATISFACTORY. DATE......�� 1�. ...................................................... Inspector-- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH §' .....................OF..---•••----:.4.......... � Y a No. .�.---. .. FEE........................ iun�!,,,orll Tontrttrtion Permit Permission is reby granted..._.__ to Construct ( or Repair ( )_an Individual Sewag is sal System atNo.. ----• . ----- ................................. ...................................................... Street as shown on the application for Disposal Works Construction. Permits No...... ....... ated.......................................... ...... ................................................................. Board of Health DATE. / --•---------------•-•--•-•--•......•....... FORM 1255 A. M. SULKIN, INC., BOSTON �' h 19 Tarawa. road Centerville, Ma 02632 September 14, 1983 Dear Sir, I spoke with someonefrom your office the other day re: the difficulties I am having in finding out about the status of my septic system. I purchased my home mn April 4, 1983. I had been told by the previous owner, when I asked about the brown spots in the- lawn.. that the system had been pumped in the fall (Nov) of 1982, This was"due to excessive summer usage". Afew days before passing papers (end March) some friends and I visited and found septic water flowing onto € the ground with accompanying foul smell. Owner said smell- must be from stagnant water draining from boat, acted surprised when sewer water was pointed out. Said she would have tanbs pumped out begore passing papers. Passed papers April 4, she announced that system hadn't been pumped as she was "too busy". I had it pumped out on April j 19 by Robert Our - bill enclosed. I had him give me an in- spection and he noted across bill "SYSTEM I8 IN FAILURE" and recommended a new overflow. I then decided that I had better find out more about the history of the system. I located the ! other pumper by calling local people but could not find the November pumping. Now the previous owner says her memory was bad and that the September pumping is the latest..?.?. Enclosed is a letter from Mr. Pina who has more recently told me that there was a lot of trouble with the system. I may get4l.-,)0�,`=_-1='letter from him further defining the situation. I believe that an inspection is in order from the Board of Health because of the history outlined above. If it is indeed "in failure" I would include the results of the inspection in my claim against the previous owner when I take my case to Small Claims Court on November 30, 1983. Please call if you have any questions or comments. Thamk you. Sincer Muriel Thomas 428-3593 - home ; 775-7213 - office IdPIdl TEL. 4:;2.053(, 20188 17 �. :, •� � :":: :lilt/• J Zr. GREA V WE N i ERiv H04D - NO. E44RWECH, MASS. 02645 3s��--- C-_I= CfSSIVh:I lFl I`Uh4PE1�. � �i/ . .. ...'it`:V!' f f,IJV" ✓�� fir+ - .�\� FFf� } C I L •L I e. /(6 i f ft` - f I V 1 C O A �, I 4 � Edwin J. Pina Sr. & Son Inc. Edwin J S. i N David C Pine o wary P.O . Box 221 Marstons Mills 02648 Tel. 428-2062 oy o F µpSSp R i June 6. 1983 i Muriel Thomas 19 Taramac Centerville, Yass. 02632 Re: Cesspool Dear Ms. Thomas : :'u: scant to our telephone oonversation of last week, here are the dates we pump- ed cesspools at the above address. 1980- July 16, 1980 1900 Gals. 1982- Sept. 27, 1982 1900 Gals. 0n SeDt. 27, 1982, 1 found that the aground around the pools : &, CO a letel`" saturated, which is an i_nd_cation that' tTie CeSspC ( E are not Graining properly, in order to correct this prob'!em i is necessary to put in a new overflow. a Regards, Edwin J. Pina Sr. rresidFnt -; . -;-? � cc t