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HomeMy WebLinkAbout0021 WINNS WAY - Health 3' WINNS WAY, CENTERVILLE i 11/�l�� J�aEcrctf��n R o 53LQR Coll HASTINGS,67N L t � �I1 Qn J �\ V 1 \\ S V yy p ilia Town of Barnstable P# • � Departiment of Regulatory Services F Public Heap (� nn �.15 MAaB. �'1�1V1S1.0II Date l:3 . 4's.7 �' 200 Main Street,Hyanals MA 02601 :•. Date Scheduled U fat Times-1 Fee Pd. • ,;gym, Soil Suitability Assessment for Sew • e Disposal r , Performed By:. Wlmossed Y. a �/ in., S Location Aridness LOCATION& GENERAL INFORMATION �� Owner's Name �O/�/�fp;✓ p Address f �/10PV J'�� kt--.,� Assessor's Map/Parcel: ' / "� �� e l777.I,' Engineer's Name a-4 k-. 1,,4 NEW CONSTRUCCION REPAIR ' Telephone# Land Use 5lopes(96) Surface stones... Distances from: Open Water Body R Possible Wet Area ft Drinking YVa[er Well . ft Dra Jan go Way Property Line --__R Other ft SIWTCIIs(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands?a proximl to holes) ) Parent material(geologic) Depth to Bedrock Depth to Oroundwater. Standing Water In Hole: Weeping fl'om Pit Fnaa Estimated Seasonal High Oroundwater DETERIVIINATTON FOR S Method Used: EASONAL-HIGH WATER TABU Depth Observed standing In obs.hole: Dei1th to weeping from side of obs.hole: In. Depth to Egli mottles: In . Index Well# Rea gdln Data: In. aroundwaterAdjusttnent ft.Index Wclt lekeiti ,q '.,}hCtor., ,� AEI•fh'cundwtiterLevel;,,,_, Observation PERCOLATION TEST Hole# - -- Time at 9" Depth of Pere �� Time at G' Start Pro-soak Tlmo @ Time(9114.) End Pro-soak / � Rate Mih./hrch �7 I . Site Suitability Assessment: Site Passed 'Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observatlon Hole Data To Be Completed on Back ***Tf percolation test is to be conducted witidn 100' of wetland,you must first notify the Barnstable Consefvation Division at least one(1)week prior to beginning, Q:\S EPT10PERCPORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munscli) Mottling (Structure,Stones;Boulders. r si tency,%'Q yell • ��-6 � to � 1 . DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Toxture+ Soil Color Soil Other. Surface(in_) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Conslatenov.%Oravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 0 1 to c O DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Soil Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,S�ottes;Boulders, consistency, i a s T lood Insurance Rate Mau: q� Above 500 year flood boundary No Yes Wlthdn 500 year boundary No Within 100 year flood boundary No. Yes . Depth of NaturaU'y Occurring Pervious Material Does at least four feet of naturally occurring pervio erial exist in allll�areas observed thrgughout the area proposed for the soil absorption system? C� If not,what is the dep of h turally occurring per lous mat'erlal? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department ofEnvirox mental Protection and that the above analysis was parfo me by me consistent with . the required training,e ' e n perience described In�10 CNR 15.017. Signature Dath QAS.EMC'\PSRCPORM.DOC No. Q Fee [Go , ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Disposal 6pBtem Construction Permit Application for a Permit to Construct( ) Repair h) Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.,-t./ &-0 Owner's Name,Address,and Tel.No. Assessor's Map/ParcelJ�,�'- Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: r Dwelling No.of Bedrooms U Lot Size d�3 L� sq.ft. Garbage Grinder( ) Other Type of Building 4 ePe P- No.of Persons Showers( ) Cafeteria( ) Other Fixtures BB g Design Flow(min.required) ® gpd Design flow provided 3-6 0 gpd Plan Date 7- �' Number of sheets Revision Date Title Size of Septic Tank_ /./'T N 6r���o� Type of S.A.S. - 1 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of H / Signed Date "X� Application Approved by Date Application Disapproved by Date for the following reasons Permit No.__ao 6 —3,5 0 Date Issued_t(r) No. r�o 1 �/ 1 Fee 6 V , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[pplication for Disposal 6pstem Construction Permit Application for a Permit to Constnxci( ) Repair(jp�Upgrade( ) Abandon( ) ❑Complete System e'ln Actual Components 4 i Location Address or Lot No.a f .�/� Jit/,e�I Owner's Name,Address,and Tel.No. Assessor's Map/Parcel­"" Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. a`G-'f7-7 - 916-677 f -� d<b ,� / .2^.✓ or.(' ,?d�i�i7 Type of Building: w Dwelling No.of Bedrooms Lot Size ao L�7 sq.ft. Garbage Grinder( ) Other Type of Building �c G�-r� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -5 c gpd Design flow provided ,>�� gpd Plan Date ©--.T/:510 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.�( -,�(� G (j CZ,,� ( CjnXM(j=r5 Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of H �th. / Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �(7 .tc J�j Date Issued J --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by //� �G�'�d�''y, - f' l'' t at / lif//I✓,0-J' ly �y ��`/✓�` has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 1' dated /U Installer �J7yj �� peC'(/J� Designer #bedrooms lJ Approved design flow �l gpd The issuance of this permi shall not be construed as a guarantee that the system will nctio a esigned. t Date 6 h ! r Inspector A -------------------- ------------------------------------------------------ --------=- -------------------------------------------- No. 0 Fee 0 s / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located atJ �j/ /+�✓� j.�Y-�y ���`i''�� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 10 � ) � Approved by � i 1 4 OCT/29/2015/THU 08:37 AM FAX No, P. 001 Town of Barnstable Regulatory Services Richard V.Seal!,Interim Director Public Health Division D Thomas McKean,Director 200 Main Street,Hyannis,P A 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Desiener Certification Form Date: 206 Sewage Permit# �o�� 11J10Assessor's MaplParcel"-'F' Designer: ��,'�'� Installer: X Address: Address: On 3 ,,,r was issued a permit to install a (dat (installer) septic system at 41W�NA'�7W�y - based on a design drawn by �,A (address) 1�°1MW dated (designer) /�Icertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of time SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct r_.A*nliance with the terms of the I1A approval letters of applicable) OF �a DAVID MASON to ler's Signature " No_1068 '41 1 FAVIO *��.. �(Designe s Signature (Affix DesignLt's N Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC B EALTH DMSION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TINS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DXVISZON. THANK YOU. Q:1Septic\Designer Certification Form kev 8-1¢13.doc TOWN OF BARN�S/TABLE LOCATION t�/ � ' / SEWAGE# VILLAGE d '�� ASSESSOR'S MAP&PARCELS INSTALLER'S NAME&PHONE NO. UTAV ,g::f ®,;-oj SEPTIC TANK CAPACITY ��1'�-�'���✓ �o o® �i$t LEACHING FACILITY: (type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the:. j►/g Pe--.4,24 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ��.Z Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) f Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching(facility) Feet FURNISHED BY A z CAIXI;�eg-g Ir AQ0 � P ® �9 36 ter'- • J re . CEP 18 1997 �; DATE: . 9/16/97 'NOFg pN .. PRO,P'( {`IfiT Y A DAD E S S: 21 4Pt'nns Way RECEIVER) Centerville,Mass L 9 S E P 1 8 1997 02632 HEALTH DEPT. MWN OF 6M On the above date, I Inspected the s-eptic system at the above address, This system consists of the following: 1 . 1 -1000 gallon septic tank. 5 . #2 pit is witin 25" of the invert of 2 . 1 -Distribution box. the invert pipe. 345 gallons before 3 . 2-1000 gallon precast leaching piiscond pit is activated. 4 . #1 pit is dry has speed leveler in box. Based on my Int co- ctlon, I certify the following conditions: 1 . This is a title five septic system. 78 Code 2 . The septic system is in proper working order at the present time. SIGNATUR!,: Name :- - J . P . Macomber Jr.,-- i ------.----- -- ----- Company: - P . Macomber &- Son�_Inc , Centervi1Le , Mass__02632 Ph one: 5CZ-7.7-5 333a------_ -. 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY .OSEPH P. MACOMBER & SON, INC, Tank&-C*upools-LsachfIeIds Pump*d & Install" Town Sewer Connections P.O. Box 66 ' Centerville, MA 02632.0066 775-333$ 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS _ DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON, MA 02108 617.292.5500 'A ILLLAN1 F N ELD TRL DY CO Goy cmor sere' ARGEO PAUL CELLLICCI D.A\ID B STRL Lt Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM COMIn ss,c PART A CERTIFICATION Property Address: 21 Winns Way Centerville,Mass . Address of Owner: Date of Inspection: 9/12/9 7 (If different) Name of Inspector: Joseph P. Macomber Jr . I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Joseph P. Macomber & Son, Inc Mailing Address: SOX bb , Me—n— erville , Ma . 02632-0066 Telephone Number: �Ub-77>—JJ3 CERTIFICATION STATEMENT I cenify that I have personally inspected the sewage disposal system at this address and that the information reported below is tfue, accura(f and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se age disposal systems. The system: -Zpasses Conditionally Passes r.la----4. F„rthar Fv;,li-arion R/Av tthv 1 oral AAnnrnvine Authoriry Ihs ectOr's 8 Si nature: �T P _ The System Inspector s all submit a.copy of this inspection report to the Approving Auihority within thirty (30) days of completing (his gnspeclion 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 Department of Environmental Protection. The original should be sent to the system ownt and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 1 5 303 ,kny failure criteria not evaluated are indicated below. COMMENTS: 8] SYSTEM CONDITIONALLY PASSES: A)elGne or more system components as described in the "Conditional Pass" section need to be replaced or repaired, The system. up.0 completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, n or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain wny not The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection. c the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltratlon, or rani failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming ,ep.c -3nk as approved by the Board of Health. (r.vised 04/25/97) Page 1 of 10 DEP on the World Wide Web: hap:/rwww.magnel.state.ma us/cep PrinleC on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 BJ SYSTEM CONDITIONALLY PASSES (continued) Nl> Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �d Cesspool or privy is within 50 feet of a surface water Z00 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: NQ The system has a septic tank and soil absorption-system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance 44� (approximation not valid). 3) OTHER (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 D) SYSTEM FAILS: You must indicate ei;- er "Yes" or "No" as to each of the following: A14 I have determined that the system violates one or more of the following failure criteria as defined in 310 CN1R 15.303. The bans for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No i Backup of sewage into facility or system component due to an 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 levelhee,,4,distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 6-4 V7-- JZ Liquid depth in eesspeel is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: Q . The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No � 1j,? the system is within 400 feet of a surface drinking water supply 109 the system is within 200 feet of a tributary to a surface drinking water supply /114 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 1� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the caner occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. JZ _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site.was inspected for signs of breakout. _ All system components, Q.Ykluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / T The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) (revised 04/25/97) P.g. 4 of 30 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Properly Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/97 FLOW CONDITIONS RESIDENTIAL: Design (low. 40 6-0 R.p> droom for S.A.S. Number of bedrooms: Number of current residents:&We Garbage grinder (yes or no):Z9 Laundry connected to system (yes or no): ' S Seasonal use (yes or no):AP r ���D� V'4 J Water meter readings, if avail ble (last two (1) year usage (gpd): /`7J �iY� f o Sump Pump (yes or nol:_ J9/� Last date of occupancy: COMMERCIAUINDUSTRIAL: Type of establish ent: Design flow: &� gallons/day Grease trap present: (yes or nold� industrial Waste Holding Tank present: (yes or no)A�& Non sanitary waste discharged to the Title S system: (yes or no)A,2p V,Iater meter readings, if available✓IW A Last date of occupancy: 1041 OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RE-/sand source of informa}y;n:, ,, � f � r r J.-C- System pumped as pan of inspection: (yes or no) If yes, volume pumped: / gallo gs Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system A.J� Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Chher APPROXIMATE A E of all components, date installed (if known) and source of information: (9a tSTi vslY1 A Sewage odors detected when arriving at the site: (yes or no) (r•vi••d 0�/JS/97) P•9• 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 BUILDING SEWER: (Locate on site plan) Depth below grade: � � Material of constructs cast iron PVC _ other (explain) Distance from private water supply well or suction line .y-4 Diameter _ Comments: (cond t g ,on of joints, venting, evident of I aka etc.) Jp"i -S ) A J SEPTIC TAN K:L,00 A;A S (locate on site plan) .r Depth below grade:�y Material of tructio Yconcrete metal Fiberglass _P lyethylene other(explain) C' >,4�yX Z�ov�r S 15c� If tank is metal, list age Is age confirmed by Certificate of ComplianceV/.-J' (Yes/No) Dimensions: Sludge depth: //++�� Distance from top of sludge to bottom of outlet tee or baffle:LJ Scum thickness:_ Distance irom top of scum to top of outlet tee or baffle: Q Distance from bottom of scum to bonom of outlet to or baffle: How dimensions were determined. Comments: (recommendation for pumping, conditi of inigyand outlet tees or baffles depth of liquid level in relation to outlet invert, structural integrity, evid' nce of leakage, etc.) GREASE TRAP: 4kwC (locate on site plan) Depth below grade: lt. Material of constructionit�concrete4JB etal,tffiberglassy�Polyethylener/other(explain) / A'/� Dimensions: Al'* Scum thickness:_�Xl Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bonom of outlet tee or baffle: 1" Date of last pumping: 1W Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) n2,�.r9SE/ J^A > lbo (z.via.d 04/25/97) Pag. 6 of 10 _ J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 TIGHT OR. HOLDING TANK:V dVt,(Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade:iVA' Material of con struct ion:4Aconcrete.f/Rmetal VAiberglass VA—Polyethyleneq�other(explain) A)R Dimensions: AA Capacity: AVA gallons Design flow: A/!g gallons/day Alarm level: NA Alarm in working order.U�/ Yes;7W No Date of previous pumping: W14_ Comments. (condition of inlet tee, condition of alarm and float switches, etc.) 1l' i; ar DISTRIBUTION BOX:z (locate on site plan) Depth of liquid level above outlet invert: 410 Comments: (note if level and di.stri ution equal, evidence of solids carryover, evidence of leakage into 9r out of box, etc.)s (,n a PUMP CHAMBER:_Nd/YA-f- (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No)_( Comments: (note,/gondition of pyymp chjimber, condition of pumps and appurtenances, etc.) Or (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection: 9/1 0/9 7 SOIL ABSORPTION SYSTEM (SAS) ;locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number. leaching chambers, number: leaching galleries, number: 0 leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: _ A-94 Name of Technology: 6tl Comments: (note conditi n of soil signs of h d auli failure, level of ponding, ndition of vegetation, etc.) 7 3 CESSPOOLS: (locate on site plan) Number and configuration: r Depth-top of liquid to inlet inven: Depth of solids layer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: y� inflow (cesspool must be pumped pan of inspection) Comments: (note co ition of soil, signs of hydr ulic failure, level of po ing condit of vegetation, etc.) PRIVY: 7 (locate on site pan Materials of construction: Dimensions: le Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) S T re (r.vl..d 04/25/97) Pag. 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SY51EM INFORMATION (continued) Propert} Address: 21 Winns Way Centerville Ma Owner: Christopher Johnson Date of inspection: 9/1 0/97 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ni N pzlb �y6 � :uo",W, 0"" 'o uolleu.Lu"", Jo po"aw C/ 9 ,,,0(Y jmffpuno12 of gidap 2IEiVVA QGWIO'dg 01 Hid3Q JZ� (z•v a•e Gs/@5/97) Page 9 of 10 100I utl{itM sPM I(E ;)=01 sy1ewq:uaq 10 sxiuwpuj sanualajal ivaueuuid off >suaj 1z 01 san apnjout SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Properly Address:21 Winns Way Centerville Ma Owner: Christopher Johnson Date of Inspection. 9/1 0/97 Depth to Groundwater,pP" Feet Please indicate all the methods used to determine High Groundwater Elevation. Obtained from Design Plans on record Observation of Site Abuning property, observation hole, basement sump etc.) Determine it irom local conditions Cnec'.. .ith local Board of heal,h Check FEMA Maps t, Check pumping records heck local excavators. installers Use USCS Data Descr,'oe in your ow,n words how you Puablished the High Groundwater Elevation. (Must be comoloro,' See Page 9 Ir•vi.•d 01/25/97) Pag• 10 of 10 I - '1'OHN OF Barnstable LOARD OF HEALTH SMISURFACF 3FHAGF DISPOSAL SYSTEM IN811FCTION FORM - PART U CF,ICrlFICATIO'� �_ F.. -- T •. .-�i ..��T.�'."�i rt.iT T T.LTTI Trt11'�—'•'1^M1TT'\R�Rr","'�1'IRTrtm�ZT'Rr1 !',+,n Tiir.•'r,Tr T+'r�• —r r r.-. -. -TYPO OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRCSS 21 Winns Way Centerville,Mass . ASSESSORS MAP , DLOCK AND PARCEL # OWNER ' s NAME Christopher Johnson PART U - CERTIFICATION I' NAME OF INSPECTOR Joseph P . Macomber Jr . COMPANY NAME Joseph P . Macomber & 'Son , Inc . COMPANY ADDRESS Box 66 Centerville , Ma . 02632-0066 5trevt Tom or City 5t,tr (;P COMPANY TELEPHONE (508 775 -3338 FAX ( 508 ) 790 -1 578 CERTIFICATION STATEMCNT I certify that I have personally inspected the sewage disposa-1 system nr- this Address and that the information reported is true , accurate , and Y complete as of the time of :inspection . The inspection was performed and an,,, recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance o `' on- site sewage disposal systems , Check one : XXXXXXXXXXSysteci PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public he:alLh or Lhe environment as defined in 310 CMR 15 . 303 , Any fail (fre criteria not evaluated are as stated in the FAILURE CRITERIA sectio:l of this form , System FAILED* \ I \" The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3tO CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature - Date9/16/97 ')ne copy of this certification must be provided to the OWNER , the DUYEf? ( where appl icable ) and the DOARD OF 11EAL1'11 it the inspection FAILED , the owner or 'oporator shall upgrado the eyote -n it.hin one year of the date of the inspection , unless allowed or require(' otherwise as provided in 310 CMR 15 , 306 , part . dc W Ul �C7 7 � ti THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF E ONMENTAL PROTECTION BE IT KNOWN THAT Joseph, P. Macomber, Jr. Has satisfied the Deparnnent's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. lunc 8, 1995 *Acuingcc4Lhcon of Watcr Pollution Control E: --- D AT _�.L1gL45_ PROPERTY ADDRESS:-1Z1--K nnG-.Wa ---------- fill -- Centerville1Mass______- 02632 On the above date, I inspected the septic system at the above address. This system consists of the following: A. 1 -1000 gallon septic tank. B. 2-1000 gallon leaching pits. C. 1 -distribution box. D. Pipe is O.K. certify the following conditions: Based on my Inspection, 1 .A. This is a title five septic system 1978 code. B. The septic system is' in proper working order at the present time SIGNATURE: Company:_ J.P, LSDn—Inc. Address:__Box_66-_-_____--__ CentervillQ_,Mas3--Q2632 Phone:----5-QB--JJ5-3338-_----- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY COS.E P. MACOMBER & SON, INC. anks-Cesspools-LeachfieIds Pumped & Installed Town Sewer Connections 66 Centerville, MA 02632-0066 775-3338 775-6412 r g draft 1113195 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOPM Address of property 21 w/NNS It/Ay Owner's name (and/or resident) &6 fe)eIoti Date of Inspection 41j ^}- PART A CHECKLIST Check if the following have been done: ,.Z Pumping information was requested of the owner, occupant, and Board of Health JL None of the system components have been pumped for at least 30 days and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained. Iv", J/� The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. ti All ,system components, excluding the SAS, have been located on the site. Y P g The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper,maintenance of SSDS. --r draft 1113195 _ SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM WFORNIATION FLOW CONDITIONS If residential �Znumber of bedrooms '6.edt''-'d V"'C i" vx"'j "ate number of current residents /Uo garbage grinder, yes or no yFs� laundry connected to system, yes or no zseasonal use, yes or no If nonresidential, calculated flow: 64 Water meter readings, if available: _ list date of occupancy �0 ✓vt c�_ az- 70 cx. GENERAL INFORMATION -,nping records and source of information: bZV System pumped as pan of inspection, yes or no if yes, volume pumped Reason for pumping:. TvW 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) Other (explain) Approximate age of all components. Date installed, if known. Source of information: /D draft 1113195 SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: YF!S (locate on site plan) c, depth below grade: material of construction: 1concrete _metal _FRP _other(explain) 1 i dimensions: �-7A L_tw"i 0 �. sludge depth distance from top of sludge to bottom of outlet tee or baffle D '' 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 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence.of.leakage, recommendations for repairs, etc.) /'Pc�„�9�i, i�ym�ec� DISTRIBUTION BOX: (locate on site plan) No depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) neu� tT fakes l d� '��o w v o draft 1113195 I1 PUMP CHAMBER:do ate on site plan) pumps in worki g order, yes or no Comments: (note condition of pum chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) i SOIL ABSORPTION SYSTEM (SAS):, S (locate on site plan, if possible, excavation not required, but may be approximated.by non-intrusive methods) If not determined to be present, explain: r-P C A.S Z �o i� U-0 /U C Type w/v W (mac leaching pits and number. (e `btj prAX h leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc.) t U Sn v4"wA kAj ��o �c - 17d C .6.rn — draft 1113195 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM DVSPECTION FORM PART B SYSTEM INFORMATION continued CESSPOOLS: (locate on site plan) number and configu ration depth-top of liquid o inlet invert depth of solids Jaye depth of scum Jaye dimensions of cess ool materials of const ction indication of groun water inflow (cesspool ust be pumped as, part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation recommendations maintenance or repairs etc.) for PRIVY: (locate on site plan) materials of constructio dimensions depth of solids Comments: (note condition of soil, sig s of hydraulic failure, level of ponding, condition of ve elation rec maintenance or repairs,etc ) g ommendations. drop 1113195 13 SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORAT PART.B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 8 d d wn1 p,7- �. 2 �� d o�✓� DEPTH TO GROUNDWATER \ /B depth to groundwater N�'`" 6 p'7— 719-1et,-� A Cvvo- �ow,� 13;• method of determination or approximation: 0LV 6M4 IT- draft 1113195 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �"1 FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or NTD). Describe basis of determination in all instances. If "not determined", explain why not) t)v Backup of sewage into facility? VO Discharge or ponding of effluent to the surface of the ground or surface waters? PO Static liquid level in the distribution box above.outlet invert? �a Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? IVO Pumped 4 times or more in the last year? number of times pumped _ /UD Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy; below the high groundwater elevation? �D within 50 feet of a surface water? �v within 100 feet of a surface water supply or tributary to a surface water supply? IUD within a Zone I of a public well? A)D within 50 feet of a bordering vegetated wetland or salt marsh? IJ0 within 50 feet of a private water supply well? Po less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. draft 111319S 15 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Ro� At,0 'v , Inspector Number l 0 6G Company Name v LAtd J- IF, 2 � Company Address ____ . zSB.,� W- VAX - $c> -777-17vcl� Certification Statement I certify that I have personally inspected the sewage disposal system at.this address and that the.information reported is true, accurate and complete as of the time of inspection. Check one: �/ I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. _ I have'determined that the system fails to protect public health and the environment as defined in 310.CMR 15.303. The basis for this determination is 61vid,d in the FAILURE CRITERIA section of this form. Inspector's Signature Date dI" 1 I G15 Original to system owner ��-'b S -441V Copies to: Buyer (if applicable) proving authority A tA/04/1995 12:46 508-428-3508 C.-.O.MM. WATER DEPT PAGE 06 KEY NUMBER <8793 > NAME <SEXTON, ROBERT > B-C 1 B-C 2 B-C 3 B-C 4 STREET 21 WINN'S WAY CITY CENTERVILLE ST MA ZIP 02632-3166 REF 1 REF 2 PHONE ( ) - REF 3 REF 4 METER NO.< 8301> DATE READING CONS STREET <WINN'S WY NO. 21> 12/31/94 815 70 CITY CEN K L2 ST LOC 06/30/94 745 44 PHONE ( ) - . 12/31/93 701 50 06/30/93 651 35 ROUTE NUMBER 31 12/31/92 616 56 SERVICE DATE 11/18/85 06/30/92 560 75 METER DATE 07/21/88 12/31/91 485 71 CAPACITY 7 06/30/91 414,---' 79 STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC X NOTE RR LEFT SIDE ADDITIONAL CONS 0 ALTERNATE MIN 0� O S 'ft,certify that the dwelling at 21 Winn's Way, Centerville, MA has been. a five (5) bedroom dwelling slice 3 when I took ownership of the structure. Mark J o h n s o v7AhG-2 �. .77,6� vse)W - SKETCH/AREA TABLE ADDENDUM File No 56205 Pro ert Address 21 Winns Way CILY Centerville County Barnstable State MA Zip 02632 Borrower Christo erJohnson �1 Lender/Client Braintree Educators Credit Uni L/C Address 482 Washington Street Braintree MA 02184 Appraiser Name Diane C.Mills First Floor 10x18 Unfinished Room Bath Bedroom Kitchen Bath 0 CN Bedroom Bedroom Living Room Second Floor 44.0' • Eaves Bedroom Bedroom Eaves Interior Not Drawn to Scale Comments: Scale: 1=14 AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Area Name of Area Size Totals Breakdown Subtotals GLA1 First Floor _ 1144.00 1144.00 First Floor GLA2 Second Floor 572.00 572.00 26.0 x 44.0 1144.00 Second Floor 13.0 x 44.0 572.00 • TOTAL LIVABLE (rounded) 1716 2 Areas Total (rounded) 1716 Jamvsky Appraisal SeMce APEX SOFTWARE 800-558-9958 Ape81Mw Apexll office(1st Floor):. , ,or's map and lot numb ' t onservation(4th Floor) rwir t ` e Board of Health(3rd floo ° Sewage Permit number �!`�T H n eu , Engineering Department(3rd floor)::, �— �Asrta` e <k T' ier,�r�ntt House number J w.i a .o M.ul Definitive PIan;Approved by Planning Board OM APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1s00-2:00 P.M.only 19 TOWN OF BARN STABLE BUILDING INSOECTOR APPLICATION FOR PERMIT TO CQ UL I TYPE OF,CONSTRUCTION ={ 19 QJC� TO THE INSPECTOR OF BUILDINGS: —�f-- The undersigned hereby applies for a permit according to the following information: Location Proposed Use Zoning District Fire District Name of Owner Address- Name of Builder Address Name of Architect Address Number of Rooms Foundation �x/0 �3 - D I�I Uc� 4,,,,,,�„ Floors Q IS�15 ��{ ��T Interior Heating �0/10EbL Y-t(� Plumbing Fireplace Approximate Cost Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab regar ing the above i Na Construction Si ipervisor's Licens r }� TOWN OF BARNSTABLE BUILDING DEPARTMENT ;5 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Stre t Address Section Of Town "HOMEOWNER" Name r� ++ Home Phone Work Phone PRESENT MAILING ADDRESS n(4)((J UV1 17 11-e City/Town State Zip Code The current exemption for "homeowners" was extended to include owner-' occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town -of Barnstable Building Department minimum ins ction procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35 ,000 cubic feet, or larger, will be required to comply with State_ Building- Code Section 1.27-0, Construction Control. HIScS No..7a:..�:v.. Fxa.... .. ...� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial �ii nrkii Ton.61rnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair (vl--an Individual Sewage Disposal System at: rn \d or Lot No. ----- � ............ l�l� .... cr. Address Address nstaller Type of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms______________ _______-.___---..-__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures . -------------------- ---•--------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow_...........................................gallons. WSeptic Tank—Liquid capacity............gallons Length__,_____________ Width.......--------- Diameter_--....___..__._. Depth................ x Disposal Trench—No. .................... Width.................... Total Length----------_......... Total leaching area_...................sq. ft. 3 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..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ---------------------------------------------------------------•--------•-•------------ --------------------- ----.--•--...---.--------- -......--•-.....---- ® Description of Soil........................................................................................................................................................................ ---.................................................................................................................. ........................... ... t--------.----------•-- U Nature of Repairs or Alterations—Answer when applicable_.. >_*OD---------------� �......... .. ....i, •---------------------------•------------•-----...-•----......_._...----------------•-......-•--------------• ........................-------------- .................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compiia -e a �ee�ni,05Z�board of health. Signed --------- ... ........... �- Dace Application Approved By ................� ... .. Dwe Application Disapproved for the following reasons: ..... . . .... ................................................................................................. .................................... . ....................................... ........... ........... .................................................................................. ........................................ Dare Permit No. ..J. ?- ..-.....................................�3 ............ Issued LX Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cex#tfictt#e of Complialare HIS IS T-t K�That the Individual Sewage Disposal System constructed ( ) or Repaired (` by .. ........... ...........X.. --------....-----..- ----------- ----------....------------------------------------------------------.............................................. at . V�1.\V.\-11Y ....�/��,,\\ �. ............ ..Ina `, V.J .. ............................_.. ........................ 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. ........._ ------------------------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1WILL FUNCTION SATISFACTORY DATE...../. a81 ...............i....... Inspector --------------- ..... .:...----..--------------- ....--------- ..------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.. ...'..... Ropoog vrhg Tonotrution famit Permission is hereby granted------- 4- � ���� 1 ............................................................... to Construct ( ) or Repair ap Individual ey, ge 's 2osal y at No......- ..... y\ ` Street as shown on the application for Disposal Works Construction Permit No.ps2-_���_ Dated........................................... DATE............. ................................. `� Board of Health !-.c2_'.�.�..:`_ : FORM 36508 HOODS 6 WARREN.INC..PUBLISHERS '+'�-•tj"-�r"i.ti�-+.-.il,.•..��...,�„ryr;..._�,,,r.._^...�r-...�.-�.r...I+-°--'"J---•..�..+ .-.�.,..:�...-�V,. yr.:--�...a�" -..�...d.. .-i_>-.�a.:,r...-r-_ ,r•la:.`�'.:.,•,Y.:.w..��.... ... .,.-V;--,�• ..:.,...,�� '_+ No.. :..jo . ,. Fas....�.��. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuit for Diripuual Wurk.6 Tomitrudiurt "anti# Application is hereby made for a Permit to Construct ( ) or Repair (V<an Individual Sewage Disposal System at: '�)-iC:N.ion-;\d 9•r s or Lot . 4 .per •.Address Installer Address UType of Building Size Lot............................Sq. feet ,.. 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. j 9 Septic Disposal Trench Tank—Liquid Nocapacity--_:--_.Width idtlons Lengthl'otal Lengthidth--------------'Total leaching area._.�epth---:...sq. ft. Seepage Pit No--------... _-----_ Diameter-_---__--__-_--._. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '_4 Percolation Test Results Performed by-------- ---------•---•--....------•----•••-•--------------••------------- Date........................................ .4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LZ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ....--•••-•........................••.......__......---•--•----•----------•..........----._......_......_..............---.....----------......------........ 0 Description of Soil........................................................................................................................................................................ U .....--•--------•----•••-----••----------------•----------------........•••-----•-•-------------•••--------------------•••--•---------•-•--------•------•-•••-----------•-----------.......•-------...... M ....................................................-...................................................................................................................J......r....................... U Nature of Repairs or Alterations—Answer when applicable......112 7---------------� .._.5 ?_.. ------------------•---------•-----------------------------------------------•--••--•--•----------------------•---------------------------------•=-------------------------------------------------...... 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 Complia e a een i su board of health. Signed .. .. .. - .--... .. . ......�.�Z r Dare Application Approved B w�-,.. .. .,r�,n ........................................................................... ......1- -.. .. PP PP Y ...... ........ J Dace..�`...-.. i Application Disapproved for the following reasons: ...................................... . . ..............-- . . .. .................----......-- -..--. .t............... ........................................ Dace Permit No. ....0 r ---.-_-&.J... ............ ..._.. Issued Date G, iL)CPaA TOWN OF BARNSTABLE im `� =`^'�►s LOCATION ��-1 Lkk SEWAGE #q VILLAGE --Zil . ( eq--t5 1 ASSESSORS MAP & LOT A-, INSTALLER'S NAME Si PHONE NOC '��\� i SEPTIC TANK CAPACITY L C) LEACHING FACILITY:{type) '{,ii� (size) NO. OF BEDROOMS PRIVATE WELL OR'"PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: r , DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Y h C. C =: I A r A T ION I SEWAGE PERMIT NO. I o q- YILLACE ' EpINSTA LLER'S NAME & `ADDRESS e UILDE R OR OWNER �Ao 71-� DATE PERMIT ISSUED F DAT E COMPLIANCE ISSUED ? � �3 i • t x i N ......�...."7 FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7f 1_<4-t,A................OF�,?.!�s!2..N1S.l? 1� ............................. Appliration for Bi-spnoial Works Tons#rnrtiun rumit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal Syst at: L n-Address ._..or Lot No. .......... :�:_ �. �C .--------------••••..._._... •••---••----....••---••---•---••-•..........--••-••••. Owrter Address W ......................�_P-- v�' Installer Address d Type of Building Size Lot. j 4___Sq. feet .0 Dwelling—No. of Bedrooms..... Expansion Attics Garbage Grinder -r ..-•-•..........--•-••-•--- — aCafeteria Other—Type of Building ............................ No. of persons.............____.._._....._ Showers ( ) dOther fixtures ------------•------------------•----•-----------•---------••--•-•------ ................................................. W Design Flow.......SS.......................... per person pier day. Total daily flow----------- lons. WSeptic Tank—Liquid capacity--8 llons Length&=.�rf. Width.,.A- Q! Diameter________________ Depth ..... . x Disposal Trench o..................... Width....._.............. Total Length__................. Total leaching.area.._.._........_.._..sq. ft. Seepage Pit No.__.._.ES____--- Diameter.......IC)___.._. Depth below inlet..___,......_._.. Total leaching area.z.6.7...sq. ft. Z Other Distribution box `l v�s Dosin tank ( 4 � Percolation Test Results Performed byTt ..... ! . .._ . Date. _ _ Test Pit No. l..4r.Z__minutes per inch Depth of Test Pit-__1__2....__.._ Depth to ground water.. Cs_�:Gtsavct 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 ......................................................•-- Descliption of S it -Q"�= 1 � . -• - � .....��.�.---- V �� .......................••-----•----••-------------•-•-----•---•----------......----------------......---........--•--------------••-•-•---••••---------•-- 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 i IILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is ued tl bo rd of health. I `..-•- ..•------•---••....-••-•---•-•• -•-•---------------------------- 11 Application Approved By.....--• �!ined ••-•--.0 e: Gy� ' , !`89 S ••-• -••-•-•........._•-••-.._.....•---- Date Application Disapproved for the following reasons:............................................................................................................... ........•-•-----•---•---•-•--••-•------••---•----...----••--•.....••-••••-------•-------...•-------•••-•.--•--•-•-•---•-----------•-•--•-•-••••---•-•-•-•---------••-••--••--•-•-•--•••---••--•------- Date Permit No..........• --r`�--r .. Issued ........................... Date �✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................O F.............................................................................. ....... Trrtifirau of Tontpliattrr THIS IS_ZQ CFRTIF Tate Individual Sewage Disposal System constructed ( Ir) or Repaired ( ) by----•-•--------- ----- ---------------------/ryi �� .......k .............................. at. ......•.----Q....................................................... ------------------n`-----•----•--�-----------------------•---------- has been installed in accordance with the provisions of TI�_5 of Th2.State Sanitary Code as described in the application for Disposal Works Construction Permit No...............................�� ........ d-ated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUN TION SATISFACTORY. DATE..................... = � ............................. Inspector............. . -Jf---- ....... ----•---•----•-••--••--•-- + THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s ,t--- No........................ FEE......-----...........-- �i����� � ��att�#� ilaiT �rrrutit Permissionhereby granted. ---- ................................................................................................................................... to Construe# oRe aid s. a Indiv dual Seaga i a� at No. ------- ,_.._... {`,. Street 'r �! as shown on the application for Disposal Works Construction Permit No....................., ated..____._..__ _+.._.__........._..._...... ........................................................... ------------------------------------•--------•------- DATE ... Board of Health &. ---- - FORM 1255 HOBB4` WAR EN. INC., PUBLISHERS �� No. .............-'7 Fx$.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .---, �g.....!.�-� ..............OF........ 70ti.::..:.! Appliratinn for 14spog al Workii Tonstrnrtion "permit Application is hereby made for a Permit to Construct (k) or Repair ( ) an Individual Sewage Disposal System at: ...... ........... Loc ho - de � or Lot No. r' ..... ....... - � .. --- Address----•------•------------------------------- -----••-------------•-------•--•--•-••-----•------------..........------•-•-------•-•...._....... Installer Address O Type of Building Size Lot..�:..__r.__...I..Sq. feet a Dwelling—No. of Bedrooms....... ................................Expansion Attic Garbage Grinder O� aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ............ •-•-----•--•-----•-----•--•--•----••-----•--•--•--••-----•-• W Design,�Flow.._.... '2. .::.............:..........gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity..l Y,gallons Length.F Width.�1.'.- .'Diameter-_..--_--__•-... Depth_ 7?.. _.~+. x Disposal T•reilch-.*No............... Width.................... Total Length_.._.____...___._._. Total leaching area.....................sq. ft. Seepage Pit No.....Y!7 ...... Diameter........10__._. Depth below inlet..... __.......... Total leaching area..7-�':_2...sq. ft. Z Other Distribution box (��t)"�, Dosing tank ( X.� p a Percolation Test Results_ ' Performed by.._Sa"x:_ "__:__.`!y.... ._... _'`!_4 .___. Date_____'7__..�7 ' -+ Test Pit No. 1...L.l_..minutes per inch Depth of Test Pit..__�._......... Depth to ground water.. f..:_. 1tt:_144 f�. Test Pit No. 2....:...........minutes per inch Depth of Test Pit.................... Depth to ground water........................ .......-•..................•-••--.._.....•----•..•...a-•...-------••-••......_.................._._....--•-.............--•----•...---....._......---- O Description of Soil-----��--%'-• `� S t 5 LUA-1-4A..... ..::_{e-..��'__A}' )iD\-(6 _ t 1 i v ......_..(.....= )... ;A r'...C�........................ W 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 iI'i 1E 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. .eKdc.v..�...-•••.---•..G Z. . � ��uAPPlication Approved By......•-•-•-•-••••...._ .....-•...................•...-•--•---•--........----....._--•-••-•--••- Date Application Disapproved for the following reasons:-----•------------------------•--•----------•-----------------••----•---•--•--•- .......-•-•••••-••••-••-••--•--•--•••....--------••----••--•-•-•----••••------••----••••-----•••-----•.•-•-••------------••-••-•--•---------•--•-•---•--•••----•--••---•---•-•-----------•--••••------ V ^, --S'/ Date PermitNo......................................................... Issued....................................................... Date DES/G/V O,4 7",9,,, • S/NGLE F.4M/LY —3 B,E0.2oDrsiJ O� d , NO G•A�2.B�ACE G.2/.c/OE.2 � 5����r 1 • OA/.[,Y F.C-Ok/--/10X3=—T30 G.PO. $qQ TAN/G=:330 X//r4'a =•$ �G P.O, l2 S �5A�3� !/SE /000 GA,L- • _O/S�oSA,C, p/T—USE /000 G.4L. S/OEkl,44.[- A e2 94 ._: /88 S.,=. 1683.E X 2 per BOTToM A.2EA = 795..c. :dcyl, rOTAL 0,0.5/6ii/c f:; O -T,a�lr 72 T7A,G 1�A/.GY F.GOLd=330 G.P.O, 44: P�2rciob.L_A. T/o /,2ATE: / 1A10 Al/N 02ES Peop• � . - ,tN Gf �F /h4ss 30 2G I�SE � q�, 4Co• , of too,, v MCHARO ,� �� PETER v l �°� o TH• X o;. . SULLIVAN 179+j ., 1, Ne 2d0E48 y No. 29733 H '.U1 �5TEF' 1'3�J I(O, EL=/OO•a �g S'VONAL G• TEST HG!-� RB ,¢ 7-/7= 4 la,a.rT BOX . /.V✓. GAL., /�t/i/ - S,ofsP 4p 4.46.• 0. 178•., 49-G s•EPr�'G 9&- y � �+seg61� ' G'.E,2T/F/EO PG OT pLg4 i t 6Tn,14Q .•o -C&9 �Cc �L.QiV ,2.E�E.2EiVoE B8 V14 r&Z- ,✓a. �OT 2 / LE.eT/Fy T�/.4TT!/E ou..artcr�G SA14mv �G, 247 23, yE.c�Eov G�Or►lPLY,S WET/,/Tiy�'S�•OE/.,//V� BaxT�.e�' ; /.u�. o� Th�� .2.EGisrE,ec�.Gorvo.Sl�.2riEYo,�S To1s/.s/GZ� �3,a 2.15T�9 3 L.9 ANz /.S iVdT .CYaovPG.4/�V A,0 Iz,,,---4x- A V 1,V_1T.e— Sh��f/.t/h�E.e�GN.S.�000��aT!�E USEp IrtC.ATION Lot � 0j r)nS f•L�`7 _ N0 . 12- -3y56 DATE 'VILLAGE �r, f�-}'Us //� Q, FEE ,�'�) 00 APPLICANT !^ rre-k7 (Non-refundable ADDRESS h LCtir�_. U -�- TELEPHONE NO. ENGINEER �y TELEPHONE NO. DATE SCHEDULED42,/2 (Applicant ' s signature . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOIL -LOG .. SUB-DIVISION NAME DATE TIME E X.P A N S I O N ARE : YES .6 NO , NG IN E E R '?� TQWN WATER PRIVATE WELL fA co BOARD OF HEALTH ' EXCAVATOR SKETCH: (Street name , etc. ,dimensions of lot, exact location of test holes and !' percolation tests , locate wetlands in proximity to test holes ) , NOTES : n 7W I`� l70 I• widds WAt--1 So PERCOLATION RA TE : TEST HOLE N0: ELEVATION: TEST HOLE NO : ELEVATION: . 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 � 6 9 9 10 ��A 10 11 11 12 12 13 13 14 14 15 15 16 16 . SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD ' LEA ING PITS__ LEACHING TRENCHES_. UNSUITABLE FOR SUBSURFACE SEWAGE . REASONS :- NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED ` N ENT P ANP gETURNED TO BOARD OF HEALTH COPY: RETAIb1ED BY APPLICANT ASSESSORS MAP :— =('I' I� , _- - TEST HOLE LOGS a� PARCEL : --_- 1) 'Ilse installation shall con)pI %vith 'Htle ValId '1'own of?j yT�tHoard of FLOOD ZONE: � U i SOIL EVALUATOR:^ �fD & IleallhRegulalions. . G - _ ��'1�`"�1' 2 'I'lie installer shall verif llie localioti of utilities sewer iiivcrts and se tic REFERENCE: WITNESS : �At.l� )DATE. i I acne >oneiits nor to installation turd setting> base elevations. ! --7 „4 # �� PERCOLATION RATE: .�, '� t-(1 j 1 3) All gravity septic piping to be 4 inch Sch ,10 PVC at 1/8" per foot. 'I'lie first 7 -_ _ _ -4// �r��y, "if", two feet out of(lie d-box to the ieaching shall be level. Cecilc `� �����-'�� 1 � � I� TH- I TH-2 4) phis plan is not to be utilized for property line deternninaliun nor any other other than the proposed system purpose p I y installation. 5) All septic components must meet'l'ille V specifications. LV 6) Parking shall not be constructed over 1110 septic components. r nbD �Z/� plJ 7) The property is bounded by property corners and property lines. to 33 _ �J3 8 O 8) 'the property owner sliall review design considerations to approve of total LOCATION MAP j �- -`- �� design flow and number of bedroonis to be considered for design. Receipt of payment for the plan and installation based on m the plan shall be deemed N� IV""1 approval of(lie design flow by the owner. C. b� I CvYi 9) 'Flie existing leaching or cesspools shall be pumped and filled with material per'fitle V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per '+1�+ �3, 'L3, 'title V specs. ('�T b 10)System components to be 10 feet from wafer line. Sewer lines crossing the ( Ij�� wafer line shall be sleeved with 4 inch SCI140 PVC with ends grouted if- e'� applicable. 'f'he proposed SAS is being installed below the water service line. 7'he line is to be sleeved as aforemeniioned and maintained in place. vi4: SEPT I C SYSTEM DESIGN l 1) If a garbage grinder exists it is to be removed and is lice responsibility of the lc �� owner to ensure such. r s,'44� FLOW ESTIMATE 12)'1 he installer is to take caution in excavation around the gas line if suck exists. Ar BEDROOMS AT I Ip GAL/DAY/BEDROOM -1550 GAL/DAY 13)'I'ice installer shall verify the location, quantity and eleva(iun of the sewer �.� 9 lines exiting the dwelling"rior to the installation. SEPTIC TANK 14)'I'his plan is representative only that a system can n ! 1 fit o a io pertY meeling _ "title V requirements. l d\ l ' 0 �5 (OGAL/DAY x 2 DAYS - I10n GAL � ,. USE 6)U GALLON SEPTIC TANK -.... . 1 1� Q,, I� l�lt7l U,Ou3 Zr ABSORPTION`SYSTEM _ . . _ .. ��t aJyr 7:..l�•%t�tz�. tur ..�.'"�-v.� / / V�� �^'� �(/� ✓"!J � �- �-T�'11d\����� �,���� l Y4, 12 ------- _ �:/ l / I�-,Cj Ir-1 0 ��t�C]F il',j SIDE AREA: X 2.-t IZ,S-j xZx o.-I (6z,29 UAvlf3 c / BOTTOM AREA X Q+ 1. 8 n N1Asor1 y if SE P c; SYSTEM SECT I ON Olt"MAq �n�oI= fo�D►�t 1a � mow.�1,?L '` JI �6 It 572, Orly gRc'ri,�"10) III'm \-N)/ I'U N�o _. ,[�� "' - W } ` b q` �� 53,5 c IMI GAL �1I� -12 Wv e_ SEPTIC TANK 5�,`T I c ���- I �►�t TAM01 71 OTC �>1 __4 �L3, S 1 TE AND SEWAGE PLAN f LOCATION : PREPARED FOR : 4$1 4>1 )r / IL T O MA . SCALE: I W DAV I D B . MASON R5 DATE: 1 s DBC ENV I RONMEOAL DES I GIJS u z EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833— 2177