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HomeMy WebLinkAbout0573 OLD STRAWBERRY HILL ROAD - Health -�' 573 Old Strawberry Hill Road Hyannis F/R A 27.3 005 a i o i i I I F i � •w • S.1 _ _ a 77 Cr o I � q c 1 CIO j f I� �V s cw, � % i ,4 1 4 j. fi i 1 I B 1 1 t j 1 1 � t , i } 1 � I j I 1 4 1 t j f I �i 4 5 i t 4k � 7j7 d t 1 3 7 t t i 7 I f - r ' a 1 I S XII 1,. t / r f i f j - j i I i � ! � r t f 4 1 � { S� t 1 4f ! Il i 1 i - 1 t l COMMONWEALTH OF MASSACHUSETTS 0' BARNS TABLE EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ` '7 P 2:. a DEPARTMENT OF ENVIRONMENTAL OTECTION O� m r tl A` (v- �!VfSfJN go®�`�° ASSESSORS "M 5"• . MA P ONO' � \ NO- TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner's Name: RHODA BOHRER ` Owner's Address: 1301 TADSWORTH TERRACE HEATHROW FL 32746 Date of Inspection: 6/10/04 Name of Inspector: (please print) JOHN GRACI,INC. 0 Py Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX.508-564-7270 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionally sses _ Needs Furt valuation by the Local Approving Authority X Fails Inspector's Signature: '6 Date: 6/10/04 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspec on. If the system is a shared system or has a design now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments SYSTEM FAILED TITLE V INSPECTION.LEACH PIT WAS FULL AT TIME OF INSPECTION WITH NO EFFECTIVE LEACHING LEFT.D-BOX IS STRUCTURALLY UNSOUND. ****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. Title. 5 fmnr>rtinn Fnrm 6/1 imno Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 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: SYSTEM FAILED TITLE V INSPECTION.LEACH PIT WAS FULL AT TIME OF INSPECTION WITH NO EFFECTIVE LEACHING LEFT.D-BOX IS STRUCTURALLY UNSOUND. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or 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. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE LAST YEAR PER OWNER. - X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. - X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply - X the system is within 200 feet of a tributary to a surface drinking water supply _ X 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 an question in Se« y q coon E the system is considered a significant 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. d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 Check if the following have been done. You must indicate "yes"or"no" as to,each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] S Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLU NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents:3 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate.sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use: (yes or no):NO Water meter readings, if available(last 2 years usage(gpd)):jb4k- Sump pump(yes or no): NO qbOD bW! O 2 V)1 Last date of occupancy: n/a COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a 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: n/a Last date of occupancy/use: n/a OTHER(describe): n/a Pumping Records GENERAL INFORMATION � Source of information: NOT IN THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a ` Approximate age of all components,date installed(if known)and source of information: II 1978 PER AGENT Were sewage odors detected when arriving at the site(yes or no): NO f F Page 7 of I 1 If OFFICIAL INSPECTION FORM—NOT FOR VOLUN TARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 BUILDING SEWER(locate on site plan) Depth below grade:20" Materials of construction:_cast iron —40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.):, TOWN WATER SEPTIC TANK: X(locate on site plan) , Depth below grade: 14" Material of construction:Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6"H 5' 7" W 4' 101 " Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P065 Owner: RHODA BOHRER Date of Inspection: 6/10/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass—polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY UNSOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no):NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): n/a I R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6'X 6' leaching pits, number: n/a leaching chambers, number: n1a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT WAS FULL AT TIME OF INSPECTION:THE PIT HAD NO EFFECTIVE LEACHING LEFT AND IS IN HYDRAULIC FAILURE-BOTTOM IS AT 8'6". CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a ti i 4 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSES SMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 Owner: RHODA BOHRER Date of Inspection: 6/10/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. 0 A-A2-A h3 2ci C 62 u 0A cu 4 22 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 573 OLD STRAWBERRY HILL ROAD CENTERVILLE,MA 02632 M273 P005 ' Owner: RHODA BOHRER Date of Inspection: 6/10/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells = Estimated depth to ground water 12+feet Please indicate check(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a. NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. I ,LOCATION S �E�WA G E PERMIT N0. lY r// VILLAGE 773- X!j II'✓.r'1.✓iy/S INSTALLER'S NAME & ADDRESS B UI'LDE R OR OWNER �9.aif�ll� �v5i ��F.✓ S� DATE PERMIT ISSUED 777 DATE COMPLIANCE ISSUED 7 /_L-7 M it t: Tec, '�K, TOWN OF BARNSTABLE 5C LOCATION S2 oG0 S°,roUo%or P.fcf ldilL SEWAGE # oa�io 3� "II,LAGE� ASSESSOR'S MAP & LOT�7ff_-par INSTALLER'S NAME&PHONE NO. '/� SEPTIC TANK CAPACITY = 'iJT�^�5' LEACHING FACILITY: (size) NO.OF BEDROOO�OMM-SS� BUILDER ORtOWNER) PERMIT DATE: `` /"o COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 1 hin faci ' ) Feet Furnished by rN ® 0 ® p Q . , No. U 0 Fee N r o THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Migoar *p.5tem Construction Permit Application for a Permit to Construct ) pUair(I Upgrade( )Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No. v�� Ili. C�+j2�/�/� Owner's Name,Address and Tel.No. �jY�/yN4r Oe.4' e!P OP ovwe w Assessor's Map/Parcel -7,r o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ?� Dwelling No.of Bedrooms �" Lot Size sq.ft. Garbage Grinder( ) Other Type of Building O er, No. of Persons J Showers( ) Cafeteria( ) Other Fixtures Design Flow �rd gallons per day. Calculated daily flow � gallons. Plan Date ':Y't:9,W Number of sheets Revision Date Title Size of Septic Tank 1>C��'T�ry /ono 69��� Type of S.A.S. 220 l Description of Soil Nature of Repairs or Alterations(Answer when applicable) i 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 by4his Board of Health. v� Signed Date Application Approved by Date 7—_4—� y Application Disapproved fort following reasons Permit No. = L� o Date Issued — 4 No. O r Fee �U 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. t� s Yes f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MAS'SACHUSETTS ZippYication for tigaat *pztem Cori!5truchon Permit Application for a Permit to Construct( )ete"pair(/ )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,'S7� R�� Gy�/L Owner's Name,Address and Tel.No. Assessor's Map/Parcel .7 o r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J Type of Building: I/ Dwelling No.of Bedrooms 7 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 0Pe4_' No.of Persons �' Showers( ) Cafeteria( ) Other Fixtures ` 'a= Design Flow �T� gallons per day. Calculated daily flowy0 gallons. t Plan Date `-T Number of sheets Revision Date Title 1' f Size of Septic Tank A000 Id 2, Type of S.A.S. W0 t?` Description of Soil r Nature of Repairs or terations(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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Board of Health. �'l�r' Signed Date �Y Application Approved by Date Application Disapproved for the following reasons Permit No. ?Lk)Ll Date Issued _7/21- 6 L/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded Abandoned( )�bry_ _ at T:7,3 0Ir,4A ►&2� 6,^'7V e4l'l LG O&e- ,40�AWIP has been constructed i accordance with the provisions of Title 5 and the for Dis osal System Construction Permit No. a ulLl- 3 6[ dated 7 , 0 y Installer, l�.Oi* —Zewaww Designer `'� �• .�1'f '� +�'� The issuance o his shall not be construed as a guarantee that the sy41e wiwill u ction a .,�7 Date d �t'f Inspector 1 A �A2!V j_ No. duL 3b/ ------------------------ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi.5po!6at *p$tem Construction Permit Permission is hereby granted to Construct( )Re air( )Upgrade Abandon( ) System located at S-1. J��prwt�.Py , ./e,'G /!"*� ,/��'.,Or /+✓f'� 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. Provided:Con tructio`n m st be completed within three years of the date of this - it. Date: �` Approved by7! �s✓ �- 1 TOWN OF BARNSTABLE ,Gt LOCATION '. ®C® ,!'� °. �' /fit �O' ®ofi- 3l SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �/� SEPTIC TANK CAPACITY we • LEACHING FACILITY: (type),,e���e,6 (size) Oa�3 :r.`. � NO.OF BEDROOMS BUILDER OR WNER PERMPTDATE: COMPLIANCE DATE: Separation Distance Between t le: Maximum Adjusted Groundwater Table and 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 1 h=faci.i ) . Feet Furnished by 4 � S� A o Town of Barnstable F.Cam,DirectW. i Pubft Heaft v Me1eT WL also Fax: 509-790.6304 Office: 508 0-4b44 __ :per Descertificadomit VArm ,ante. �jAY � � Dcr� Wo 14 D Addrt A, = 1 ss• t tz `0 1) �.�I�' was issued apc=it to'ndmU a On _ 'OLD5TQqc�B�( Ij1 l�Lsed on adesig�►drawn by {address) - � ({AIPt90W 3 ` to I i the a sysa refer of the y to nd war appmo�ed • oas6a�asd/arsep��- �v&h► c4anges Cs e. firenced a�� DCSi s�Stamp S Q.HeOdOJWdOV4SiPWCaMficadOv Form L'0 CAT 4 N , SEW-AGE PERMIT NO. l..ILLAGE / R�. INSTA LLER'S NAME 6 ADDRESS . B.UILDE R OR OWNER .,, "DATE PERMIT I S S U E D w GATE COMPLIANCE" ISSUED - t. , r ' ..♦ / `. ��1 r t �� A � �`�' I �� `� � ', �� � r��c . fi� Y �1 � N J—� - 1 Y /—��' z • '�A l)L�. j r )� �, c r. � � /I� (F//� No................. ^ ' _ FEE.... '<,x._ THE COMMONWEALTH OF MASSACHUSETTS v _ SOAR® OF HEALTH M " ...............OF..... 1 T :...... , ppliration for Uhip gal Works Tonotrurtion Frrmit Application is hereb made for a Permit to Constru t (�or Repair ( ) an Individual Wag akgv. /Dispos System at: 7_j .. .11.. ......... ..............._-- 2. ..... _ ---�? ------...-----------------•-•----......------.. Location-A ss J Lot No. ®caner Address, ^q� a- ' -' .......................................•• d�!�l�Il-�i� --. 14 Installer Address d Type of Building Size Lot_.l___y_ .? ...Sq. feet U Dwelling—No. of Bedrooms.............................................Expansion Attic Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other .fixtures .----•--•--•--• •-••--••-•••... - S.0....................•__gallons per person per day. Total daily flow.--........3_.�........_.........gallons. W Design Flow....... .. g p p p y. y WSeptic Tank—Liquid capacityjLkV.gallons Length.....:.......... Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No........I------------ Diameter.... .y..Qa... Depth below,,iet... ..... Total leachingarea..................sq. ft. Z Other Distribution box ( ) Dosing nk ( ) �d a Percolation Test Results Performed by._..... -_ _A........... - :�._......... Date._. `__.... •-•-••-_--_-. Test Pit No. 1......c�_ ____minutes per inch epth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil----R� ..... �.. .............................................. W . UNature of Repairs or Alterations—Answer when'applicable................:.............................................................................. -•--------------------------•-------------------------------------------•-------•--...----••------------•-----•----------------------------------------•............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is y oard of hea_lt . Application Approved By•-•_-..... --- •• ...... ••-•••---•- Date Application Disapproved for the following reasons---------------------------------------------------------------•----------------••---------------•-•-••..._•••--- -•-----••--•--•---------------------•......------------------........-----•------•----------•---•--......------------------......-----------------------------------------------------------•••--•--•••- Date PermitNo......................................................... Issued....................................................... Date 01 •l �~ - _ a L i�a+4r r F` /THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF HEALTH ................OF...... Appliratiun for Uispao al parks Tonotratrtiun amit Application is hereby made for a Permit to Construct (VT or Repair ( ) an Individual S� ag Dispo System at: g..1t.. Location- ess Lot No of wner Address Installer Address Type of Building Size Lot:. _..Sq: feet U �... ,.a Dwelling No. of Bedrooms.. Attic ( , Garbage Grinder ( ) aa Other—T e of Buildin No. of'Persons......................... Showers YP �, g. ---------••----•---•-------- --- ( ) Cafeteria dOther fixtures .......................................................................................................... w Design Flow....: .: _ .......................gallons per person per day. Total daily flow.......... . ._.:gallons WSeptic Tank—Liquid capacity -gallons Length................ Width................ Diameter................ Depth..............: t x Disposal Trench No............ ...... Width... ...._...... Total Length__...... .... Total leaching area....................sq ft. Seepage Pit No `__ ____________ Diameter _ rrt_ ... Depth below iet_._ Total leachin rea.........:_.._..sq. ft. Z Other Distribution box ( ) Dosing?epth k ( ) �� �nt` 3' ��' 7� '-' Percolation Test Results . Performed by...... '¢.t....'_._. •.......... Date...-'�'�'" .¢.� ' .....--- minutes per inch of Test Pit.................. Depth to ground water........................ Test Pit No. 1..:_: .____ 44 Test Pit No. 2................minutes per inch Depth of Test wPit............ .__.... Depth to ground water...._................... 9 --------- ..................................................................................................................................... ODescription of Soil... !n.................................••......-•--------------------..-..-----------...---•--::........---------••--•---..._.. x 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'ITi.;:;. p S of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is rl y e oard of healt . igned_.. «......+ - . • Y to Application Approved By--- --- • . ------ . .. . . =................... ----- ....«• '?'���'�"" Date Application Disapproved for the following reasons---------------------------------•-----------------------------••----------------•------.._......------.....-•--- ....................•----...........----.....--•--...--•-------------- •-•-------=--••---•-----------••-----------•--------------------•----••-...-----•-•-------------•----•-=-------•-••------------ Date PermitNo..................................................... _ f Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSET4\ , » BOARD OF HEALTH .....: ................OF.....B '" + . .. .. ................. T rrfif iratr of ToutpliFaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (401T or Repaired ( ) by..... _ Installer at........ ... `.. > i t .................................................... has been installed in accordance 'with the rovisions of TI" r p 4w/ The State Sanitary Code as described in the application for Disposal Works Construction Permit No.^t..._..___._ :.............. dated---- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON UED AS A GUARANTEE THAT THE SYSTEM WLLL F NC ION SATISFACtORY. � DATE... ....................................... Inspector.. ..._... :.......................................... THE COMMONWEALTH OF MASSACHUSETTS 3 � ' BOARD OF HEALTH *5e. r ............ OF.. ......--••----•-------•••. - ! No....... FEE—..................... Disposal antic Permission is hereby granted... .. to Construct•° ) or Repair ( ) an Individual Sewage Disposal System at No .. ,{�,, , ` • -- ._• + •Street- ............................................... as shown on the application for Disposal Works Construction •lei 1 No.... Dated../!"`........:................................ ' oard of Healtli DATE:......... ----... .................................. FORM 1255 HOBBS'& WARREN, INC.. PUBLISHERS- Q Cj1 UGL'E• �-�'.'/1/1..t:1: -( - 3 81':�tZ1JUM Q ►moo G,ntz$,�t= �r-�I,,tn� � �Et�-Ic TA�tC = 330,e I=,o % _ A-95 G.P.D. 19 J uSf--- t DOCK GAL. J r ISPos oL PIT - USE 100o GAS-. O Ct 9/AL.L Av-EA = t'So s•t=. -" 15a s;=- $c rT-rD,cA A.tZEA= eO ST-. n n` Too-AL- -C:) J = .42S G-RD. To"TAL T�dtLN( f-t1Duu = 33p6.W. µNz TAU a 0 /hUJ ,r p.6o1( f 2 V �fLCOt.D.T10L1 2l�TE I" ImIW• orz LF-SS. -- ul �. z o 1 a. 11 0 y„q E!P +i 1ARD 1 O O, 9 6 AXTER I-i TesT FG s9 Tom >'wo =,oO.o LoAW P�� l o0o IWV. SJF�� 4rp,PP blSr. Jo 1 f -BOX 7t.90 Seeric INv. Tea P4 I o00 9S.6 t i1N• .', GAL. �ri.o tic,za LEA,c I-1 �A PIT e: WAS►•IED SAiJr, STONE. F3 i, i Pczo F=t L_i� L O CA T l o» 1-I y A\ N N t S -- IZ IJo W n�E►`L. P k o Po S 6 tom. 1 G V tz T t 1=�{ T (A T" T N Ir 0 u ©p.'t't0r S t 1a�v►J Pl.A t-I TZ-=P E W-c t.i c& t l�.l,t_Z�tJ CC lr'L�(S W IMA TNT= �jID�.LI►-IE: OT is AWr-> 'SE✓T[',ACIG �."CQtJ1�:Erl�c:� 1TS OP -TOVJ L 1 OT= S A- tV SfTA%$\,.e- (� 3 z & 4:5 /'� �20 {/.t,{n,y , T 3 ���--" E�h.�CTC -T-t-�t�, t�t_A I`I I� t,��T c„n•;c.ca �1••-; r+.� Ii�1+rl'�':Jl,��l_�1�1 i �i:J:_c/t=.ti' � T11(_: c.:t=t=�;-=r�r il•�LE..ILD n.l�l�l_1 C_1�.1--1T !- , 1•k,�l- tit'_ U :G� 1"C, t�r_l i_i_+«tkJl- CAP[ l CjE i/E.�VC-,,, �'+ ASSESSORS MAP : ----- _ z —_ TEST HOLE LOGS PARCEL a0 NOTES: G NAW ---- -� SOIL EVALUATOR , n � ManeG FLOOD ZONE fne.Ane;, o WITNESS-: 1 _G 1� i Dept w v REFERENCE: �3 �""jg�,� C� f�s � G DATE: 1) The installation shall comply with Title V and Town of Barnstable Board of 3° PERCOLATION RATE: L Z l�,11 t�.l. 1 /c , � �{ � - • r �°� Health Regulations. o, $s4A µE , Y The installer shall verify the location of utilities, sewer inverts and septic TH- 1 TH-2 components prior to installation. ~' Z)4 — 9 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. 4) This plan,is not to be utilized for property line determination nor any other O� AIpWAYpR� � S g �' purpose other than the proposed system installation. ER o KOREDR 5) All septic components must meet Title V specifications. 6) Parking shaot be constructed over H10 septic components. LOCATION M A P(976) 7) The property is bounded by property corners and property lines as depicted. 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the C� ! plan and installation based on the plan shall be deemed approval of the number of bedrooms. � 9) The existing leach pit shall be pumped and backfilled per Title V Abandonment Procedures. 10)Proposed leaching is to be within 36 inches of grade or provide vinting or cut grade as permitted by the Board of Health. ¢' 1 i)System components to be 10 feet from water line. 12)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., SEPT I .', SYSTEM DES I G N then replace with 15000ST / + FLOW ESTIMATE �c78' BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY SEPTIC TANK ��O GAL/DAY x 2 DAYS OM GAL J USE 1000 GALLON SEPTIC TANK Q�1 b'TlLJ Gc� JNJ i`^t q- 6r? OIL ABSORPTION SYSTEM r� d414 s= r }C j 1••� � � UJ'�_,1..�...1 - � '1 �'` ;..SIDE AREA: � -�t- L .}C 0, 9 I BOTTOM AREA: SEPTIC SYSTEM SECTION NA1 I ' L tA ? �--.�—�,�_ . ��.--�.� " • t � ��>��N rat�t—r�. u t �'p1�'t�ll �fjV1t17 t tJ 51 _ _ GAL O SEPTIC TANKlam I ` SITE AND SEWAGE PLAN + LOCATION : POLL xs , >, PREPARED FOR : 0 0 SCALE: Vet w - DAV I D B . MASON R5 DATE: Z Z DQC ENVIRONMENtAL DESIGNS w D HEALTH AGENT EAST SANDWICH . MA ATE w . ( 508 ) 833- 2I77 Z .