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HomeMy WebLinkAbout0189 LONGVIEW DRIVE - Health F Longview Drive nis51 — 083 Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection .Titl One winter Street,Boston,Ma. 02108 D.E.P. Title V Septic ' c Inspector P.O. Box 2119 Teaticket, MA 02536 (508)5G4;�G813 WILLIAM F.WELD / Governor ARGEO PAUL CELLUCCI V v� Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ��ii PART A. CERTIFICATION " 3 11998 IOFgA Ca Property Address: 189 Longview Dr.Centerville Address of Owner: �AtT& 211PTI'LE Date of Inspection: 3/27/98 (If different) Name of Inspector: John Grad Davie .f I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: 0t "r CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V _ Conditional Pa ses code 310 CMR 16303.My findings are or how the system is y performing at the time of the Inspection.My Inspection does _ Needs Fu er valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Fails * septic system and any of its components useful lire. Inspector's Signature: Date: 3130198 The System Inspector shall s mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any Information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoThpllance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127)97) One Winter Street • Boston,Massachusetts 02108 is FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 189 Longview Dr.Centerville Owner: Davis Date of Inspection:3127199 _ SewaQe backup or.breakout.or. high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to 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 leveled or replaced i —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 pipets)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: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has aseptic tank and soil absorption system and 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis 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 Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. — Discharge or pending of effluent to the surface of the ground or surface waters dale to on ovorloddod 01,clogged cesspool. SAS is in hydraulic failure. (revised OW7197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 189 Longview Dr.Centerville Owner: Davis Date of Inspection:3127198 DJ SYSTEM FAILS(continued)' Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 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. 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. E] 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: 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 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 li 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. refted 0412INT 1 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 189 Longview Dr.Centerville Owner: Davis Date of Inspection:3127199 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. -x— — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x 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. x 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 Systens. . x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)[15.302(3)(b)J (rwlsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I' PART C SYSTEM INFORMATION Property Address: 11891-ongvlewDr.Centerville Owner: Davis Date of Inspection:3127198 FLOW CONDITIONS RESIDENTIAL: Design flow: 9 P d./bedroom for S.A.S. i: Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if a-v ilable:(last two(2)'year usage(gpd). nia Sump Pump(yes or no): No Last date of occupancy: nib COMMERCIAL/INDUSTRIAL: Type of establishment: nib Design flow:8 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nfa Last date of occupancy: nib OTHER:(Describe) nia Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has never been pumped System pumped as part of inspection: (yes orno)No If yes,volume pumped:8 gallons Reason for pumping: nia TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system 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? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: - 1968 Sewage odors detected*when arriving at the site:(yes or no) No (revised 04117)91) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 189 Longview Dr.Centerville Owner: Davis Date of Inspection:3127199 SEPTIC TANK: x (locate on site plan) Depth below grade: t' Material of construction:x concreate metal FRP Polyethylene—other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: 1_e16^H57^w410" Sludge depth:3 Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness: Distance from top of scum to top of outlet tee or.baffle:s" Distance form bottom of scum to bottom of outlet tee or baffle: IT" How dimensions were determined: measured 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.) Septic tank and all components are structurally sound and runctloning properly.Recommend pumping now and then maintained every two years. GREASE TRAP:_ (locate on site plan) Depth below grade: Na Material of construction: _concrete_metal_FRP_Polyethylene other(explain) Dimensions: Na Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:Na Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumpingri1. 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.) BUILDING SEWER: (Locate on site plan) Depth below grade: iw Material of construction: cast iron x 40 PVC other(explain) Distance from private water supply well or suction linetown Dia meter: 4"_ (;�mments: (conditions of joints,venting,evidence of leakage,etc.) (revised 04f2T19T1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 189 Longview Dr.Centerville " Owner: Davis Date of Inspection:3127199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rya Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nla Capacity: nla gallons Design flow: nla gallons/day Alarm level:_we Alarm in working order?_Yes No ' Date of previous pumping: i Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nfa DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: liquid level vvithbo8omofpipe Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) D$ox Is etrudzelly sound. PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No. Alarms in working order(yes or no)_ve: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) rda 4 ' (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 189 Longview Dr.Centerville Owner: Davis Date of Inspection:3127199 SOIL ABSORPTION SYSTEM (SAS):X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: Na leaching chambers,number:6•hmnutratora leaching galleries,number: Na leaching trenches,number,length: rva - leaching fields, number, dimensions:nia overflow cesspool,number:nIa Alternate system: Na Name of Technology:_Na Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) SAS la functioning properly. CESSPOOLS: (locate on site plan) Number and configuration: rya Depth-top of liquid to inlet invert: Na Depth of solids layer: rya Depth of scum layer: nla Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na 4 inflow(cesspool must be pumped as part of inspection) Na Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY: (locate on site plan) Materials of construction: rda Dimensions: Na Depth of solids: nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Iravlead 0427/97i I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 189 Longview Dr.Centerville Davis 3127198 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) 5 W1 l+cCI— %wq E=I Pay ! o! 30 pwlud 0A117197► - - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 189 Longview Dr.Centerville Davis 3127198 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts r. e (revleedO4117197) 19p• l0 of 10 TOWN OF BARNSTABLE LOCATION Tr� G,i,��-d!� �/*. &9,SEFS§ ^ SEWAGE# —VILLAGE ' ; SOR'S MAP &LOTR 6 INSTALLER'S NAME&PHONE NO.OZ4%,e- ,Po 6l 4/So iv 7, -9 7 1C SEPTIC TANK CAPACITY /. ors LEACHING FACILITY: (type) !`I (size) �Y r NO.OF BEDROOMS BAR OWNER 9 G./11 0 K PERMITDATE: COMPLIANCE DATE: Separation Distance etween the: ` Maximum Adjusted Groundwater Table and Bottom of Leaching Facility l Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ' grfacility) Feet Furnished by ttf -,�- � /� r �� r �' 1 No. 2� Fee 40.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYtcatton for Mtgpogaf *pMem Cow6tructton i3ermit 5 �� Application is hereby made for a Permit to Construct( )or Repair( x)an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 198 Longview Dr O MCFarland Centerville Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Service P.O. Box 1089 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(no) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) install a 1 ,500 gal septic tank, d—box and Title 5 leachtrench Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of alth. o Signed 4 Dat d Application Approved by Application Disapproved for the following reasons Permit No. Date Issued r No. i Fee 40.00 Q THE COMMONWEALTH,OFF MASSACHUSETTS PUBLIC;HEALTH DIVISION - TOWN & BARNSTABLE., MASSACHUSETTS - �. 01pprication for Migo!5al *P , em><Con$truction Peruiit S ;! Application is hereby made for a Permit to Contruct( .�.or Repair(!-man Qn-site Sewage Disposal System at: Locution Address or Lot No. ft Owner's Name,Address and Tel..No. 198 LongviewiDr £ j MCFarland - Centerville Inst .e ' N e dress,and Tel.N -- -� Designer's Nag1- Address and Tel.Not", . . %bbb�nson Septic Service j P.O. Box 1089 IN - RGfZJ­­­ Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(nq Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow ` gallons per day. Calculated daily flQw� a gallons. Plan Date Number of sheets r '' Revision Date Title sand Description of Soil Nature o XRepabrsr f,Qilter�atilnnss(Answer nwhen applicable) ��1 a 1 r 500 gal septic tank / Cl �O a� LLe Ilk $4 Date last inspected: 'Agreement: F The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system .:'` in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. o ' Signed Date %e Application Approved by t Application Disapproved for the following reasons ' r{ Permit No. Date Issued ''THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS `t Certificate of Compliance - x. THIS IS TO CCEERRTIFY that the O -sit Sewa a Disposal System installed( )or repaired/replaced(X )on by, y W.E. Robinson 1 c Sgery for McFarland 196 as 1 LE'.rVl a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisio s t forth below:- i No. ( J Fe e40.00 a a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migpogar *pgtem Construction Permit Permission is hereby granted to W.E. Robinson Septic Service 1 to construct( )repair(X )an On-site Sewage System located at 198 Longview Dr Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All constructs n must bp completed within two years of the date below. Date: v (� Approved by • I CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concernit*the property located at cJ G `� 2 meets all oI'the following criteria: i • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system .The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. { - - w 4• SS 4f f jam` ] `t^,3t �" - 1 x SIGNED DATE. LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER In a certi}led plot a em Also if the licensed installer , [Attach a sketch plan of the proposed cystposers p p this plan should be submitted]. fx a • _ - F' i �� 3f a 3�. � v I�-- << 5 1 'gym �. � � o�1 TOWN OF BARNSTABLE " LOCATION SEWAGE # . y� VILLAGE R PASSESSORS MAP & LOT,9S7—M3 INSTALLER'S NAME & PHONE NO. 0ytT000_1_17 SEPTIC TANK CAPACITY /__3za5d 7y/L LEACHING FACILITY:(type) (size) Toe. 3 � NO. OF BEDROOMS PRIVATE WELL OR UBLIC WAT�tR_ BUILDER OR OWNER ,3z,()ez U/_ DATE PERMIT ISSUED: %//��:�L DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 -�.n O �_ �" ® � f� No- ..........._....... Fps.. 6.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPROVED TOWN OF BA R N STA B L E Barnstable Conservation Department Appliratiuu for Uiupuuttl Works Towitrur to 11-16 9 Cate Application is hereby made for a Permit to Construct ( ) or Repair (X an Individual Sewage Disposal System at: �v ..� ................................................ ..............wliqnj..�......... h�cajhon;IAdcjtess / / / O �' • ... ----.3. '- - off .< . ........v'... . � . O or rot •---•�y: ''V _„........... � ��t(�m�.v/i7 �"�on��T. 7��- �✓`rV„`�r,Q L/ /`Ldl Add��aA1S�.. Installer Address + d Type of Building Size Lot., ..Sq. feet U Dwelling—No. of Bedrooms._.._._.. •--- Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Buildin yp g •--------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .............................................................................................................. W Design Flow_________________ . ..............gallons per person per day. Total daily flow................ 0...............gallons. WSeptic Tank—Liquid capacity?�Pq..gallons Length_ Width................ Diameter---------------- Depth................ x Disposal Trench—No. ..__....�........ Width......7......... Total Length_..& Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet-------/......... Total leaching area..................sq. ft. Z Other Distribution box (><) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................ Ix .-•••-••--••---------- ---••-•--•--••----•--•••••---••--•----.....•---•-•......------._._......---............................................ -------•---•-/-•---------.....•---_---- x . Description of Soil...................... �= ..... L1� n_ QI ---- 5 �� • J--- --•-•-•---• ..------..fZ -----------------------•-----------------------------------•-------•----------------•-•---••-- W U Nature of Repairs or Alterations—Answer when pplicable. '�-.._.1._Za ____ .._77J _.f_.. i.. _... � ------......%�N -----•---------•-•-•---••-•----------•.............................•-•-........ 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 ha bee i ue the board of health. Signed ---- ---- ---- - -- - --------- -----....................... .. �/....... , Da[e Application Approved By --- ........................ .......... - Application Disapproved for the following reasons- ....................................................--.I—. .—..----- ------------------ - --............ - ------------------- ------ ............................... 11 ....5;W-- ------------- Date Permit No. /�/�..t(\(}..� ---....... Issued �` T ................. ...................--..Date................----....----.......... ?0_�� No... �Q...................... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tnnstrnr irrn Application is hereby made for a Permit to Construct ( ') or,Repair_'(,4 an Individual Sewage Disposal System at: ........• ................................................ .....CU.IL«------= ( ......... 0 ocation-Address o o. - .... __ •-.- r .............. -- Owner Addres w �c 7 Go^J..57-. 76� vtJ rl QY 2D . ,_ 2s�o s - .... - - - -- --------------------- -••-- (� Address _ Installer � - U Type of Building r Size Lot. ,.dBO__- __Sq. feet I—, Dwelling—No. of Bedrooms.........�` _..�...............Expansion Attic ( ) Garbage Grinder ( ) aOther—T-ype of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures -----------------------------------•---------------....---------------....------------...-------- -------------------------- _..... W Design Flow.................... ..............gallons per person er da Total daily flow--------------------^�© - --------------gallons. WSeptic Tank—Liquid capacityZ� ..gallons Length._,. Width................ Diameter.-•------------- Depth................ x Disposal Trench—No..........Z....... Width...... ......... Total Length._2Sv 'Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet......../......... Total leaching area..................sq. ft. Z Other Distribution box (>4) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ W 4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... OLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .--••--•------------•---••--•--••••••••----••---••••--•••••--•-•--•-•--••......--•-•......-•-•---•--.......................................... O Description of Soil....................... ... C ._ �.:11I_?'?�_ U3�Sd i[ . �g (xj �7_ .._... N .................................----------------------------------------------•---------------------------•---•--••---- W U Nature of Repairs or Alterations—Answer when pplicable..!!a—'-1 4 Q�._ _?C•._ ...--•---•-•--------•--•................................ Agreement: I r 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 Complianc ha bee .issued,.. y the board of health. . g ............ . ---.... .. Application Approved By ,--- 1�.� ... .`l Dare a1 ------------"--Dare.................. Application Disapproved for the following reasons: ......---- .............................. .... ............... ..----......... --------............... ................................................I....................................... PermitNo. - � ------ ---- ......................................-- ........ ---------..-.: Issued -.....................------------ ----- -------------- -.-.--------------- Da . .,... / re \(f✓//1 Dace r+ r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance / THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ^�. ) by - Installer at ...-...... - ........J ......... ......"1[,.. CJ l�.r�...... .------- .d ._------------C' i has been installed in accordance with the provisions of TITLE o The to.ems vironmental 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 WILL FUNC� ON SATISFACTORY. DATE... ----------­--­-- .........................................---. Inspector ....---..... 1)----------------------------................................. THE COMMONWEALTH OF MASSACHUSETTS / BOARD OF HEALTH _ TOWN OF BARNSTABLE No. ..�..... - FEE.��.......---- Disposal Works TUnns#rwtion prrutit Permission is hereby granted..............Z49f IJ-e&7T/------...... 0-'-J's to Construct ( ) or Repair ,(-(/) an Individual Sewage Disposal Syst atNo.................................................1.E'9--••••---•- �i4jC1`(/J�� .. !(/�_.. . ,� .---------------•----......... Seet �' ��yr � as shown on the appli tion for Disposal Works ConstructionPear t No:�/__`eI-... Dated_. �___•----------------------- = - dr ^ Board of Ifiealth DATE------(-/--- f/ � � _'- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS