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Home My WebLink About0008 SUNNY-WOOD DRIVE - Health 8 Sunny-wood Drive Hyannis x P Y 273 215 ti MM a 9 Commonwealth of Massachusetts ----_ ` Title 5 Official Inspection Form __ 1= Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -% 8 SUNNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name -- isrequired for CENTERVILLE MA 02632 3/19/07 _ every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your MICHAEL DEDECKO cursor-do not use the return Name of Inspector ---- key. COMPASS REALTY DEV CORP Company Name ee P.O_ BOX 2384_ — m -- Company Add— ress MASHPEE MA 02649 re" City/Town State Zip Code 508-221-5003 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ! r 3/19/07 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approlving 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 DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address -- --'- CATHERINE MCDONOUGH Owner Owner's Name '—^ —l----"� information is required for CENTERVILLE MA 02632 3/19/07 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: 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: 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. ❑ 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: ❑ 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 281OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts _-- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments :;•'° 8 SUNNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name -" --------- information is required for CENTERVILLE MA 02632 3/19/07 _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: 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. 281 OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SU_NNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name ----' information is required for CENTERVILLE MA 02632 3/19/07 __ __ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 ❑ LK Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded U 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 ❑ V Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: El 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. 281 OLD MEETINGHOUSE•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address --— CATHERINE MCDONOU_GH Owner Owner's Name - — —---- information is required for _CE_NTERVILLE MA _ 02632 3/1_9/07_ ____ _ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ F�r Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ E2 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.] ❑ V 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. I E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 281 OLD MEETINGHOUSE-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 8 SUNNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name information is CENTERVILLE MA 02632 3/19/07 required for -------------- -- ------- — every page. City/Town —— ---- Inspe tion ---- -__.._....__. 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 i ❑ Were any of the system components pumped out in the previous two weeks? E ❑ 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? d ❑ 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? ❑ 12 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. 2/ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue i approximation of distance is unacceptable) [310 CMR 15.302(5)] 2810LD MEETINGHOUSE•08/06 'Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address ---------------- ` - CATHERINE MCDONOUGH Owner ---------------------- -=— -------......--------- Owner's Name information is required for CENTERVILLE MA_ 02632 3/19/07—_ — _ every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): -- ---------- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): "-� �--- Number of current residents: -------- Does residence have a garbage grinder? ❑ Yes 2--`No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes [9"No Laundry system inspected? ❑ Yes D'�No Seasonal use? ❑ Yes ["No Water meter readings, if available last 2 ears usage d --�� 9 ( Y 9 (9P ))� Sump pump? ❑ Yes Lg' Igo 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: -- - ----------- Last date of occupancy/use: —-Date -- --------------- Other(describe): ----- --- 281OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE roperty Address C_ATH_ERINE MCDONOUGH Owner Owner's Name — - —-- — information is CENTERVILLE required for _ MA _02632 3/19/07 _ every page. City/Town State Zip Code Date of Inspection — D. System Information (Cont.) General Information Pumping Records: Source of information: V-; A Was system pumped as part of the inspection? ❑ Yes Lam' No If yes, volume pumped: ----------------- - ---- -._..---.._. - gallons How was quantity pumped determined? --- -------- ----.-.-- Reason for pumping: Type of System: 2" 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): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes [2"'No 281OLD MEETINGHOUSE•08r06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address --------------- — CATHERINE MCDONOUGH Owner Owner's Name —— -- ------------ requrnformat edo r CEN_TERVILLE re aired for MA 02632 3/19/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): i Depth below grade: —__—.____._._..______.. feet Material of construction: ❑ cast iron [r40 PVC ❑ other(explain): -- Distance from private water supply well or suction line: ---- feet Comments (on condition of joints, venting, evidence of leakage, etc.): S T �"� VN► r�U �% T LQc%-t'�ti- C -----._...---- Septic Tank (locate on site plan): a Depth below grade: feet Material of construction: econcrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years - Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: --------------------- !- Ir Sludge depth: tv -_-- -------. Distance from top of sludge to bottom of outlet tee or baffle Scum thickness = — ----- -- —J— Distance from top of scum to top of outlet tee or baffle ------------------ - /j Distance from bottom of scum to bottom of outlet tee or baffle —4- -------- -- ------ - - How were dimensions determined? 281OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15'' Commonwealth of Massachusetts _M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .S 8 SUNNY_W_OOD DRIVE Property Address — CATHERINE MCDONOUGH Owner Owner's Name information is CENTERVILLE required for MA_ 02632 3/19/07 _ _ ___ _ _--.— _ 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.): J.;_�.� �r"rv,y�in�� i eC.'S t iG9Gl�sjl�vc_Tv,-t prsuL��_ ��..�:.U��u �.- Grease Trap (locate on site plan): Depth below grade: feet — ---- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain). Dimensions: — ----- --------" Scum thickness ------—---------------------- Distance from top of scum to top of outlet tee or baffle --------- ---------- -"- Distance from bottom of scum to bottom of outlet tee or baffle - ------------- --- - Date of last pumping: Date — - 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): 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address _C_ATHERINE MCDONOUGH Owner Owner's Name --- information is required for CENTERVILLE MA _ 02632 3/19/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert`` `J � ' �'-''�� ---- - Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any eviid�ennc�e of leakage into or out of box, etc.): / r Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 2810LD MEETINGHOUSE•08f06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 SUNNYWOOD DRIVE Property Address C_ATHERINE MCDONOUGH Owner Owner's Name information is required for _CE_N_TERVILLE MA 02632 3/19/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: leaching pits number: 11 �O---- ❑ leaching chambers number: -- --------- ❑ 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.): ? C i L .., Yi►fi!/L� } L I- �� n� �y✓L'�v'1 �/��i;i�� ;, i. —v`.�-f��T1rs °.� I��U�'r!�'1�!. 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments .,,teq� 8 SU_NNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name -----""---" - - " information is required for _CEN_TERVILLE MA_ 02632 _ 3/19/07__— _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): r - y 281OLD MEETINGHOUSE•08106 ' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 SLINNYWOOD DRIVE Property Address CATHERINE MCDONOUGH Owner Owner's Name ---- information is required for CENTERVILLE MA 02632 3/19/07 every page. City/Town State Zip Code Date of Inspection' . D. System Information (cont.) 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. LJ 3 51' P->J- 3C3 -.3s 5, 281 OLD MEETINGHOUSE-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 - . . ~ Commonwealth of Massachusetts ��~��N�b �� u��~��N N��~�� N~0�� mo�n�� "� NN��N�wN Inspection �-~�� mm _MTr Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 8 SUNNYVVOOD DRIVE p�pertyAddress CATHER|NE MCDONOUGH Owner Owner's Name ------�--------------'-------------- information ia required for CENTERV|LLE MA 02632 3/1907 every page. City/Town State Zip Code --- 0}, System Information (cont.) Site Exam: ��nF Check Slope | EJ Surfaoewater F� Check cellar Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: L] Obtained from system design plans onrecord |f checked, date nf design plan reviewed- Date El Observed site (abutting property/observation hole within 150 feet cfSAS) [� Checked with |000| Board of Health ' exp|ain: Checked with local excavators, installers ' (attach documentation) Accessed USGS database ' explain: You must describe how you established the high ground water elevation: _- --_---___-_- ^ | ` 281OLD MEETINGHOUSE-08/66 . Title 5cfficial Inspection Form:Subsurface Sewage Disposal System'Page`5m`, . ` U COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �E�EwED PARCEL LOX o 2-tP__��W AUG 2 5 2004 TITLE 5 TOWN OF BARNSTABLE HEALTH DEPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNT SESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 8 Sunny Wood Drive "M MA 02632 Owner's Name: Margaret&Joseph Aries Owner's Address: Date of Inspection: August 11, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 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. 1 am a DEP ,approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditi ally Passes Needs er Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: August 15. 2004 The system inspector shall subm'4copyy 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 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 ****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 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 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: 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. 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: 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: 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 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 "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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of inspection: August 11, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the 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 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.] No (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 System: 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ 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: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 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 j Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 1988-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Mar¢aret&Joseph Aries Date of Inspection: August 11, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 8" P Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. Recommend pumping. i I ' GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August ll, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on.site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACJE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 Qal.) leaching chambers,number: 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.): The leach pit had Y ofliauid on the bottom. The scum line was approximately at the same level. There did not appear to be any sins of failure. The bottom to grade was 8'. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 i Page 10 of 11 i OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION (continued) i Property Address: 8 Sunny Wood Drive Centerville, MA Owner: Margaret&Joseph Aries Date of Inspection: August 11, 2004 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. i A �ALIC Q I a 133 31 3 3 3) 33 3yi63� II, y 35 so 10 i i i Page I I of I 1 i j OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) I Property Address: 8 Sunny Wood Drive Centerville. MA j Owner: Margaret&Joseph Aries i Date of Inspection: August 11, 2004 SITE EXAM { Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) j ✓ Checked with local Board of Health-explain: Topographic and water contours maps i Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps the maps were showing approximately 30'+/-to ground water at this site. i This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 Q TOWN)OF BARNSTABLE L LOCATIO V SV WUO C. r. SEWAGE # O " j VZ,LAGE ll. "7 NN N ASSESSOR'S MAP & LOT-1: 2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) PST la X(o (size) f NO.OF BEDROOMS 3 J BUILDER OR OWNER A PERMTTDATE: 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 leaching f cility) /' Feet Furnished by 1 - LIN J w p D fib TOWN F BBARNSTABLE OCATION EWAGE # U 4�I1LAGE ffi�A AbV ASSESSOR'S MAP & LOT NNSTALLER'S NAME & PHONE NO. 4 f „&y ` 2- G9 K EPTIC TANK CAPACITY LEACHING FACILITY:(type) L� ,� r f (size) NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATERf"� BUILDER OR OWNER . rfl3bL6 ' DATE PERMIT ISSUED: —gel- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No v`� w w a a •+ 11�� cw, 4 % ' I .... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH ----...... w............:.....OF......z4111. 6rxvi le........................................... Appliration for Uh4poiittl Works C�bt�t��ftitn PXXIttt #�r Application is hereby made for a Permit to Construct ( � lypLi( ) an Individual Sewage Disposal System at: ....:..��.. ... �.............SU.rV.cll .....----•• 1��rvrU� - Locatio -Add ess or N y_<... � Ow er Address Installer Address // �/ Type of Building Size Lot ..... .�5�._�J D..Sq. feet Dwelling—No. of Bedrooms...........5........................... Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------•--------------------------------------------••----•--•---•--•••••-•-•--------•••-•----......---••-••••-- Y 1 Y : .. .............•-••lons. W Design Flow..................... .�..(,)_..........gallons per person r;r Ala Total daily flow........... gal WSeptic Tank—Liquid capacity J.Q.C.gallons Length__ ..._.. Width.. ..`/6. Diameter................ Depth.. x Disposal Trench—No. ................... Width.................... Total Length.......-....... . Total leaching area....................sq. ft. Seepage Pit No----------�......... Diameter....-0),�....... Depth below inlet.....,,�r......� Total leaching area....9&.- Lsq. ft. z Other Distribution box ( �) Dosing tank ( ) Percolation Test Results Performed by.......641V .`4 J� Cl&.4rIb C ....... Date....... ...... Test Pit No. 1.....¢ .._._minutes per inch Depth of Test Pit.................... Depth to ground water......................... Lc, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pi ,..... ............................... 0 Description of Soil.....0 �f ....: .�.,vr c l �- �• �4 2 1! .....CI_.:J3.�,---�.� 6L6,sa.,,Z...ozp�...`�:?�it�r� x ------ ------1 /3....CAMZ04.....Pff---.�s�clf-------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable..................................:.... .....................................4.................. -........................-........................................................................-•--••--•-•-•-••••••-•-•-----••......-----•••••-•--•-•---••-••--•••....._...0.....-••--•-•.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System'in accordance with the provisions of iITLi, 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be 7issd by the board of health. Signed....... ................................ Date Application Approved BY �5 " t ................................ Date Application Disapproved for the following reasons:-----------•-----------------------------------------------------•-•---- ..................................... ---------------------------------------------------------------------------------------------------------'----------------------------------------••---••-•••--•••-••-•--•••••••••----•-•---•....:.....-- Date PermitNo..... ........................._.... Issued............-.......................................... Date No....00.....�?l._ F$s..... -� THE COMMONWEALTH OF MASSACHUSE17S BOARD �OF HEALTH ............�w ............OF....... /5:?/�l�rLb / <7/ ........................................... Appliratiun for Disposal Works Ton,strurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal`) System at• 1 .......�a ............ ........... -••---...........�y'!..rUr1l�S /__ :............................ ;�ocatiog ...-A ess e h7 ...:... /��. r... .�._L....... s ......... ........_ . . .. :°:..............................._....... L°l�eya ---------------••-- ........... ..............-•--------..... . ...................----........ . ..... Installer Address / Type of Building Size Lot...........................Sq. feet 1-1 Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( ) 44 44 Other—T e of BuildingNo. of ersons............................ Showers a' � - -•...........................................P ... ( ) — Cafeteria ( ) Other fixture 71111*111111-...... Design Flow.................... gallons per person n day. Total dai y 0 '� G ,fi ....................�1 ns. / WSeptic Tank—Liquid capacity./. .6.4 Mons Length................ Width... Diameter................ Depth................ x Disposal Trench—No .................... Width.... Total Length......... �total leaching area...... .sq. ft. Seepage Pit No..........1..-..... Diameter.....�c +._..__.._ Depth below inlet...... 1.......! Total leaching area.. __r.sq. ft. Other Distribution box Dosing tank ( ) Co� Cl/lUl� CG Date-••.... o_: .� r�._... a Percolation Test Results Performed by........ ...............�...._._......... _. Test Pit No. I...........minutes per inch Depth of Test Pit.................... Depth to ground water.......................... fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ IYi ......................... --.---- / D Description pf Soil-.....7....f�. !....T ..11t'?Lc'>/�lv/�<i �_, T. y*.............../>l�c .... 1... c.� v{ �------ '- ................ . -- 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 TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b Issu d by the board o�hhealthh. Signed......•. ............. .... Date Application Approved By....... ..--•................ -•-•-------.. ...... J Date Application Disapproved for the following reasons:---••-•-------------•--•---•-•--.....----------------------•-•-------------...-------....................--- ..-••........................•...••-••......••••....•-•-................••....•••-•--•....••-••••••--.......•-••-•-•-.............---•••--•-•••••••••••....••••-•••-.................................. Date PermitNo...... K-- 61............................_ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ..........OF.................:...........................:...................................... 01rrtif irate of ffoutplianre THIS IS TO CERTIFY, Th the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ( .. .... •......•--••-•----.....-- -I ......................:.....•--•---••---------•-................................. . -•---... wtwftr at ... L7`.... -.46 ti? ------ has been installed in accordance with th provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated..............r.................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A ARANTEE THAT TIDE SYSTEM WILL FUNCTI ATI FA RY. DATE........:........ ............................. Inspector....... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...�6.-1. /.. ......... r Z: ........OF............ .1 ........ ..................... F>�...... 7 :. fRisjros 1Works trudiott Perutu Permission is hereby granted..........I P?- --.-.---.... ........................••-----...................•................................__.. to Construct (><or Repair ( an Individual Sewage D, isposal System at No.••••••••-••••Ulr-,7....2,1....... ........ �.'_� r..(rf -----1-•J.A_e . . . .....----.....................---.........------...................... ......... �r� V Street as shown on the application for Disposal Works Construction Permit No.8 .�61_._ Dated.......................................... ..................................... •+.�-••--....--•-••-•-•-......-••••-••-•--.........._ . Board of Health DATE......................... '1 --: b�................... FORM 1255 A. M. SULKIN• INC.. BOSTON - r THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH ..... t..N............................OF........-.BARNSTARLE-------._.._...-----........................._. Apphration for Dispas al Works Tonotratrfion #rrmff Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: �'v.v�yWOe)b be ✓� Lot 26 ya11�'.? l_4. •--•-•-- ......... ...... i ............... _..c..•---•--.......... .... ---•• --•-•........... I Location-Address or Lot No. ......................—.........................................................................r ............................................. ----........ .......-_-----........... W Owner Address a .......................................................•------•--•••--...----_......---._.....-- -•--•---...-••-------.....................__........_... ---._.....•----••--....•--•--.....•-•- Installer Address 16 ,038 j Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..................3._______._.______.._.__Expansion Attic ( X) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow.......110 gallons per person per day. Total daily flow.......U.0______________________________gallons. A; Septic Tank--Liquid capacity_1000gallons Length___._$_.-6_ Width...4 -10_ Diameter................ Depth`�_ _.4_..__- I x Disposal Trench—Ni. .................... Width�.._._.._.__._.___ Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..__..__-.-- Diameter____________________ Depth below inlet_._ ....... Total leaching area._251_........sq. ft. Z Other Distribution box (X ) Dosin tank ( ) '-' Percolation Test Results Performed by.. �.Cod-Survey_-Consultants...... Date..... 0--9-84---__•___-_____•••. I ►-1 L 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............... qH OF�yj�� O De i of Soil.............#1 - Top and subsoil• 3 -9 sand and avel " A fIOGER P. � coarse find sand.'-•-TP"2 0-3' •toy-and subsoil, 3-9 sand•-and------------- �_ aAUL � i v gravel �,=T3' coarse to find sand.--------------- - -•----------- o nlffCHNIEWICz x --=------------------••-•--•--..__._....------..__..._..---_....----•-------•--..__.___..----•--..__...---------------..__...---------._....------------•-••--•-•-•-••-----••-•.._.._.. 5?_.....No.30420 C.0 U Nature of Repairs or Alterations—Answer when applicable............................................................................... 'AF,_CIVIL Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor'flance with, the provisions of TITLE 5 of the State Sanitary Code— The unders• ned further agrees not to place the system in V �� operation until a Certificate of Compliance h ends ed by the bo of health. Si e .____ • /- pate Application Approved By ................ .:. /v 1 19 I Date Application Disapproved for the following reasons-------------------------------------•--••--•---------------------------------•-•--•----••- -------•----- ...--------•-•----•------------------•-•-•------•----'-----------------------•---••-•------------•--•----------------------------Date•--•-••------- ' Permit No......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............................:................. wrtif irate of Tontplitanrr THISr � 1 0 CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired by �.1.,r-'�'ll � --•------•---•--••------------------------------------•-•-•--......-----•---....._._ ). Installer ............................... . has been installed in accordance with the provisions of TITLB 5 of The State Sanitary Coe as described in the application for Disposal Works Construction Permit No....... ." .......... dated_--..!_�!_��....................... ti THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................................... .... ------- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................O F...........--..-....._:..:_.........-..........._.._.._......_........_.__.... No. �.-9 . .. FEE........................ RaposqQlVorko Tuonstrurtion rrntit Permission is hereby granted......... --------•-•-•-------•-------•-----------•-•-----------------•--•--.............. to Construct ( or Re air ) an Individual Sewage Disposal S,Zstem at _.._ .c1�1�11�V Street as shown on the application for Disposal Works Construction Permit No..B.f4.7' `�3___ Dated__.___/A L-/�!l............... �.1�----•--...---•----------------------------•---------...-•--••---••..._...._•-_---•-- Board of Health DATE_ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No:K�..1.-4 1 FES... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :..-.TOW.........................OF...........BAKNSTAB•L-E............. .........--................._- ppliratiun for Dispo.o al Works Tonotratrtion rantit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal i System at: Lj�/il/•l/ � �O e� ��/'lOC .............L,ot 36v - ----__----•---------- ••....._____._._...._._.............-••-••---•-----•-----•--••---...........---•-.._............_. Location- ddress or Lot No. ......................—................................................................-•--•--... ._.....----••----•-•••••---•-•-•..............................•-•••-............................._ Owner Address W ' Installer Address 16,038 UType of Building Size Lot_______________________.....Sq. feet �.. Dwelling—No. of Bedrooms__________---------3-____-__--__-_-_--_-_-Expansion Attic ( )0 Garbage Grinder ( ) i aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .. ----•-•--•--------------------••••---------------•-•-----------------•---•--•---•--••-•••----------.....------..........-----------......--•--- W Design Flow........1.1-0......................______gallons per person per day. Total daily flow.......330-............................gallons. 9 Septic Tank—Liquid'capacity...12b fjallons Length------V_-vvvidtti..-..V.__10`Diameter................ Depth.5;`A Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.........a---------- Diameter-_-_ 2..._.-_._. Depth below inlet___.3.6.7....... Total leaching area...25i1........sq. ft. Z Other Distribution box ( X) Dosing tank ( ) I a Percolation Test Results Performed by....Cape..CM1.S=E?y_.ClmaultaC1ta..... Date.....1.0-9ma4.................. Test Pit No. 1._,-2_._..___minutes per inch Depth of Test Pit____________________ Depth to ground water.......................... 44 Test Pit No. 2..........•_____minutes per inch Depth of Test Pit____________________ Depth to ground water..............._... � ` a .................=......................................................................................---•--........--•.......------•-__--••. 'tq{OF/lp O Description of Soil_._-" P#1 0_-3° TU..__c'�n1__$t?k?�?��.i..��°=�c ��?��; ----------------------- �- U' 9 e-13°- coarse_•to--find-_acmdp RI 5 `'` �i.•._ ® ROGER sfe, o , Z 0" _... _. _. 3 r "s _ ....•---- ._._...-PAUL . avel 9 --13 coarse � f sax�z,-_______ o MICHNIEuvICZ 0- iVo:30420 � U Nature of Repairs or Alterations—Answer when applicable. _A �j...C-IVIL p --•--• Agreement: ------------------------------------------------------------------------------------------- N� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accor e the provisions of TITTIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in 1e.0e7:� operation until a Certificate of Compliance has been issued by the board of health. '. Signed = ............. ApplicationApproved By. -------••-•••••-------------------•••----------------------------------_.._ ................................•....... Date Application Disapproved for the following reasons:.................................................................................... ... _________________________________________________________________________________________________________.-.____.____________•________-_.____._.___-_.---_•_______.___-__.._-_-___.-.___._.__.__.._ti.___ Date .� PermitNo..........................................-.............. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... C-Llertif iratr of TompliFaurr THIS 1$40 CERTIFY, That the Individual Sewage Disposal System constructed ( X or Repaired:'(17 'at---Z=. -. cJ�±/// Zr /) r - t 1 Installe •---- ---•-•- - : •��.- - - --- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Codel a's described in the application for Disposal Works Construction Permit No:.._.____ r *-'p K.�-.____. dated........... f.1. � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................................•-•--•---------•-•-••-•-•-••--•-••....... Inspector.................................................................................... C THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.....................-............. ..------..-.....-..-............ �CjD 0. No... . FEE........................ Uiopoou� urko �unotrudion. rranit Permission is hereby granted-------��7- -i l _mod= ---••-•••-••••••----•••-••••-----.....••-•-----....•........................•--- to Construct ( or Repair (r, ) an Individual Sewage Disposal System at No.-L`__-�-'------ ---• 7 ��= lJ Street.f/.1/!. %/fir i%b. nl�f`—` �1.�''./i ii i •7 �r j -- ••- as shown on the application for Disposal Works Construction Permit No.__-.£�.` � Dated.._.__.../��1 r..:-��_..._....... --•-------------------•--•--•••-•----------------..._-----•------..._.._..••----•- Board of Health DATE................................................................................ j FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS