The URL can be used to link to this page

Home My WebLink About0030 NEWSPAPER ROAD - Health 30 Newspaper Road Q A=253-012-001 Hyannis r �ii +I �zt,, Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� COPS 30 Newspaper road Property Address Robert Swanson Owner Ownecs_Name information is +I Q h I S"}�C required for —y s4.53 MA 03632 4/20/2012 every page. City own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the •t � � I � I , computer,use 1. Inspector: only the tab key to move your wayne Archambeault cursor-do not Name of Inspector use the return key. Company Name _ Box 914 Company Address Hyannis MA 02601 'ed0" City/Town State Zip Code 508-775-1362 355 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the in p tion, Thfiejnspec4ion was performed based on my training and experience in the proper function and maarttenancei4 on 44 sewage disposal systems. I am a DEP approved system inspector pursuant to'S'ection 1"40 p Title 5(310 CMR 15.000). The system: µ r� ® Passes ❑ Conditionally Passes ❑ Falls s ❑ Needs Further Evaluation by the Local Approving Authority 4/20/2012 ,,�pe&Grs Signa re �/ Date i' The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under ' . the same or different conditions of use: 1z, t5ins•11110 Title 5 Official Inspection Fonn: b ace Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist,Any failure criteria not evaluated are indicated below. Comments: DISTRIBUTION BOX AND SAS LOCATED UNDER ASPHALT DRIVE UNABLE TO INSPECT B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by , the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. p System will ass unless Board of Health determines in accordance with 310 CMR Y 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) . 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool , t ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•11/10 f Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is Centerville MA 03632 4/20/2012 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply r ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection ° Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, ; or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.-The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑, Z Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information' Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins•11116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump'pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: OWNER Was system pumped as part of the inspection? ❑ Yes ® .No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 11/14/02 permit#01-390 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 2 1000 gallon tanks hook together to make up 2000 gallon capasity for 6 bedroom house If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: (2) 8.5'x5'x5' Sludge depth: (1) 3" (2)2" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA, 03632 4/20/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle (1) 38" (2)40" Scum thickness (1)4 (2)2 Distance from top of scum to top of outlet tee or baffle (1)4" (2)6" Distance from bottom of scum to bottom of outlet tee or baffle (1) 10" (2) 12" How were dimensions determined? measuring rod Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank 1 has concrete tee in inlet in good condition and pvc tee in outlet set to correct height tank 2 has pvc tees in both inlet and outlet both tees set yo correct heights both tanks show on signs of leaking or structural.failure Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): ti Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 Newspaper road Property Address Robert Swanson Owner Owners Name information is required for Centerville MA 03632 4/20/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade.- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments q 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information' (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert unable to locate under asphalt drive Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: 4 ❑ Yes ❑ No .Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): k Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: unable to locate under asphalt drive t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.), Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): design plan shows 4 500 chambers with stone around unable to verify due to location under asphalt , drive Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert° Depth of solids layer Depth of scum layer Dimensions of cesspool ` Materials of construction Indication of groundwater inflow ❑ Yes ❑ No , t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids ` Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 attachment 1,654x2,153 pixels 4/21/12 8:38 AM APR-18-2012 10:33 From:BARNST HEALTH 15087906304 To:5887718012 P.1/1 AsBuil( Page I of 1 TOWN OF BAMSTABL�, EliTCs`��l L�i'C LOCATION SIr51`AGE N OI`3 7 CS VILLAGE G / ASSESSOR'S MAP&LOT-Zy-::e/z•eol INSTALLER'SNAML&PHONE NO. If-6b r r0 �✓ 'r 9 z SEPTIC TANK CAPACITY �2--AO,0 -' LEACHING FACILITY,(type) 4 (Size) NO.OF BEDROOMS ,Zi` BUDDER OR OWNER f 71 S` PERMITDATE: '.°.lU�(`:.� COMPLIANCE. DATE;.&-/`/- Separation Distance Betwceq the: Maximum Adjusted GroundwaterTabie to the Bonota of Leaching Facility feet Private Water Supply Well and Leashing Facility (If any wcUs exist on site or within 200 feet of leaching faciliry) Feet Edge of Wetland and Leaching Facility(IF any wettands exist within,300_feet_of leeching fzgiury) Feet Furnished by _.. y' r Y d i o hitp://issgl2/iritran6Upropd,tta/prebuilt.aspX'lmappar-25301200I&seq-1 4/18/2012 https://mail-attachment.googieusercontent.com/attachment/?ui=2&ik...n6&sadet=1335011918036&sads=2igmi9b9gTBB7uNX7Pflgvllxlw&sadssc=l Page 1 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name information is required for Centerville MA 03632 4/20/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date 1 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: . ` You must describe how you established the high ground water elevation: design plans on file at barnstable board of health Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 Newspaper road Property Address Robert Swanson Owner Owner's Name ` information is required for Centerville MA 03632 4/20/2012 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BA.RNSTABL5- LOCATION A SEWAGE# ®/_3 VELLAGE / SESSOR'S MAP& LOOT 2S3-00-6ol INSTALLER'S NA &PHONE NO. ME . �bb �inLs'd �'✓ �`�J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) G� /7�v°2-U (size):/.3''��-S' I NO. OF BEDROOMS G BUILDER OR OWNER PERMIT DATE: j� -0 r fr COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0 i �All I No.�. Fee $5 0 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: YeZ � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZppYication for Digpogar *pgtem Comaruction Vermit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. A30SSoNSe1�'aP�aa�er Rd. Cente vd le Margo Wharton Pisacano Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of,Soil Sand Nature of Repairs or Alterations(Answer when applicable) Install an additional 1 ,000 g a l tank, If 20 D—box and 4 H 20 precast leach chambers with stone ail around. 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 thi o of Health. Signed L �' Date - G Application Approved by Date Application Disapproved for the following reasons 6l-� A PennitNo. aMW Date Issued TOWN OF BARNSTABL LOCATION SEWAGE # 0/ C� VILLAGE Ali a ASSESSOR'S MAP & LOOT 2S3—al9t-Ool i INSTALLER'S NAME&PHONE NO. �,52"e s'd �J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4j"'/7�v -� (size) /, NO.OF BEDROOMS G BUILDER OR OWNER Jr L"� C) PERMITDATE: Z-V-0-6 COMPLIANCE DATE: r/`�-' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �0 lu 1 d J-� 6 A. i s i _ �� Cff_ b If j� = M �, ,...:;' '1Vo. ✓�/ _ �.-�-_._ ..�.. � � Fee $5 0 Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes r .4 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS�' N Zippfication for Mi5poga1 *p5tem Construction Permit ~ Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. A30SoI spaer�er Rd. Cente ville Margo Wharton Pisacano ` Installer's Name,Address,and T&No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville a Type of Building: Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder( ) Other ,-', Type,, f Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day..Calculted daily flow gallons. Plan Date Number of sheets" Revision Date 1 Title • . Size of Septic Tank Type of S.A.S. ` Description of Soil Saed Nature of Repairs or Alterations(Answer when applicable)- Install an additional 1 000 coal tank, H 20. D-box andj4 H 20 precast leach chambers with stone all around. f i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system r 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 iss ed by thi o of Health. Signed r c i r-> Date 6 6 Application Approved by J Date Application Disapproved for the following reasons 1 Permit No. f Date Issued } i ----------- ----------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Pisacano, certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic"-Service 0 pp Centerville Newspaper R . , Ctille at3 ha a constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N ated Installer Wm. E. Robinson Sr. Designer The issuance of this permit shall not be construed as a guarantee that the systeE,_ ill function as designed. " Date �"" 19—t)� ✓f" �fi In�ectt�// ��1) A(V•1 /2 No. �(/ / dwt� "Fee T "5 0 THE COMMONWEALTH OF MASSACH'S'E�T�T PUBLIC HEALTH DIVISION - BARNSTABLE�,MASSA U,"A Pisacano 1wigpogat 6potem %"on!Aruction 3J,Perritit , Permission is hereby granted to Construct( )Repair(X )Upgrade( A a d)`� on4-( Systemlocatedat 30 Newspaper Rd. Centerville] t `� and as described in the above Application for Disposal System Construction ermit. The-yap`phcant recognizes s. er duty to % comply with Title 5 and the following local provisions or special conditio�., ,Oe t Provided:Co�n/stru ion must a comp eted within three years of the date o pe Date: / Approved by -� --/ l�IOTICE:' bkk Form U To'Be Used For the Repair Of Wiled Septic Systems Only. C�ItTi�iC�►'1`ION OP SUCH AND APPI.ICaTIOId FOR A DM O- SAL WORKS CON19MUMON PEBAofff(Wt'f1HODT DESIGNED PLANS) William E_ Robirlson,S> y co-tify dm do appfication Lo cousucttctioa parook sped by tine dated .�o -concenwe the ply[ocated at 30 Newspaper Rd. , Centerville meets aA of the fo OWing caiieriW • The failed Wsteaa-is orran=d to a nuftodd dv eWmg a* "thus ate no commercial or busium um ossoaimed M�h the daeSing The soil is cb7l as CLASS I and Ibc petootadom race is less than or equal to 5 minanes pa inch - There ore no wtxlands wi bin Nld fact of the proposed gcpuc s}Vtetn — - Thy we no wdb within lie li=OR the Proposed scpw SYSMUi There is no in Saw andlar i is Ux p9lo wmd There me variances meted or needed. The of the �t7r v n w-6e kmmd teas than five Sea abc w the °gamadjumd 9MwmftMr tabIe elevation fAdjus tt meter table uwag the Frimptor medmid appbMwPI if the S. S.wit!be with 250 fees of any vqpawd wedandk the bottom of the pqmsed te:duft bcfli[Y will W bt Ion less than fauteca(141 f=abaft tree tna�duwita adju swd gmenchva"table dC ration, Pic ase compkie time A) Top of Graved Sn> oe EkVwift tam GIs whunfim, B) G.W.Ekvation +tht:MAX. tit G.W _ DIFFERENCE BETWEEN A aW B -- — � SIGNED: v l DATE-. � r PIM O W=on badcj_ %F bmkb folder cca T �, � ;� O� �__ Ci`' � ,�, ��-- � 1. t a �� ----�_ �6 ' y + A .� '� a ! F I. i , i r { k' , t ; i ----------- --I. 1, 1 r 1 - i r 1 J�i ~r ? . ,. _:_.._. :_- ,� -+' I--f '-----'- - -I - - -- - - '}- - -�- -- - -`fir--�-' -- -_ •__.---r - ..,__ -' �--- - - __ .:. - ' I � r I �- !! { r , J I , i - k r t i i I o- I t ~ J , I {. r- I , I , r,----------- _.._ -_Y -F._ -._-___ .- ._ __ _ L , r Y L—11, : - r. -- '-. ., t-._ ._.. "'_—�_'_--_f• ., ._.6---�-...-� - --Y---. ,. .F_--—ice--- "-'- t,- __ __ __ _ _ _ ___ j! JI B �a 1 r �' v 1 : y , 1 3 IQ _ � r f .. � ( f , ....__._.• _._.., ice__ ._ �._ ;.._ _..__... _F-_ .. _r_._ _ _�._....-. y ____ _._ _ a_ .. _�_ ,___..__ _ _ __.— - __.. -, .._ ,..__ > i f, ,... ...... t Y , , , �� -z �.�.�f i ,''', �p �S�— o/�—ova f