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HomeMy WebLinkAbout0124 CAP'N CARLETON'S RD - Health 124 Cap'n Carle#on's RbaJ �r'�e - - - - - - -- COt -- A 038 040 it { I f v COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION I •� ;A s+ �Ala • PARCEL ;_�`(Z® TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 124 Capt.Carlton Road to Cotuit MA 02635 `=1 CID Owners Name: Omar Smakiewicz Owner's Address: Same r� ,l co Date of Inspection: July 22,2004 W ;r Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO, " co Mailing Address: 189 CAMMETT ROAD — MARSTONS MILLS MA 02648 Telephone Number: 508-428.1779 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: �����ti0Fr11Jts;N�� _X_ Passes "•°" °•`�O''� Conditionally Passes J AT C " to � � Needs Further Evaluation by the Local Approving Authority ! :M Fails • L :co Inspector's Signature: Date: `7/22/04_ The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the 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: Leaching pit#2 is half full with a high stain 6-8"above current level. 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 I Page 2 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 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 I 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: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARV ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SVSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 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 %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 —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 I 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 fi•om 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 forma _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 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 _ 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 11 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. ., Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 124 Capt. Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 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)] Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 124 Capt. Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms): 440 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): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2002—97,000 gal. 2003—60,000 gal.=215 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMM ERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CM 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: Pumped on 4/26/04&4/7/00 Source of information: Barnstable WPC 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 __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): Approximate age of all components,date installed(if known)and source of information: Tank and leaching pit#1 are original to house. Leaching pit#2 installed early 1990's Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: V Materials of construction:_cast iron X_40 PVC_other(explain): Distance from private water supply well or suction line: 35' Comments(on condition of.joints,venting evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:—X—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: 8.5' long x 5.2'wide—1000 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 27" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees intact and clear,liquid level at bottom of outlet nine GREASE TRAP: No (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.): Page 8 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Capt. Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 TIGHT or HOLDING TANK: No (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: X (if present mist be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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.): Liquid level at bottom of outlet pipes PUMP CHAMBER: No (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.): Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Capt. Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: Two 6x6 pits. 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.): Original leaching pit had previously failed and is full to too Second leaching Dit is half full with a high stain line 6-8"above current level Recommend maintaining active leaching pit in 3 5 vears CESSPOOLS: No (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: No (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.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewicz Date of Inspection: July 22,2004 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. Capt. Carlton Road 2(0 l j JZ 1000 gal tank 2— 1000 gal pits Page 11 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 124 Capt.Carlton Road,Cotuit Owner: Omar Smakiewica Date of Inspection: July 22,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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) _—Checked with local Board of Health-explain: —Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Groundwater contour map shows groundwater at el.20 and topo map shows property above el.40. TOWN OF BARNSTABLE LOC A;rlON ApT C R,QG eTO V'S . SEWAGE # Y /— VILLAGE C 07*0/T ASSESSOR'S MAP & LOTS 3 f' d INSTALLER'S NAME & PHONE NO. I to ti! A c oM/3 eg t SEPTIC TANK CAPACITY 4 0 O a LEACHING FACILITY:(type) /�/ � (size) ,NO. OF BEDROOMS .3 PRIVATE WELL OR PUBLIC WATER R OR OWNER L"�1 pry ,�/yilg/ r� crr z� DATE PERMIT ISSUED: ,1. 'DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r a i i Q O / A � I ' r f ). f l� A No.....Ty. -_,. APPROVED THE COMMONWEALTH OF MASSACHUSETTS © 38 BOARD OF HEALTH .�S nLEI a TOWN OF BARNSTABLE '`T DM Apphration for Uivjipoottl Wurlw Towitrnrtion Pamit Application is hereby made for a Permit to Construct ( ) or Repair OCX)C an Individual Sewage Disposal System at: 124 Captain Carltons Road Cotuit ............................................................•--------...------.................... •---••-----------.........------------------------•--....--------------........------.....---..... Location-Address or Lot No. Emir Smayki ewicz ......................-.......................................................................... •---••••----•---------•-•-•-------•-------------•••----------------•-------------.......---------- Owner Address W J.P.Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet Dwelling x-No. of Bedrooms-------------3.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.......4.................. Showers ( ) — Cafeteria ( ) A4 Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width.--------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No---------_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.-.--.-.-.---------- Depth to ground water...----------_---------. Test Pit No. 2................minutes per inch Depth of Test Pit........---.--..---- Depth to ground water........................ a ----•-•-••------------------••-•--------------••••----••-•••-•-•-•----•-----------------------------......................................................... 0 Description of Soil----------------------••-------------------••------------------------------•--------------.Sand.................................................................. x U --------•--••••--••....•------•-•-----------•-•------•----•------•--••----•--------•----------------•••--------••••-------•----------•••----•....-••.....-••-•-•---••-•------------------•-----------••- W UNature of Repairs or Alterations—Answer when applicable-...Ad-d...arlcli-onal---Leachi-a ....pit---t0...an... e«ist•ina tank & bit . •• ------...0----------------•••-----•----•----------------------•--•-------•-••-•---•---•-•----------------••••••--••••---•---•-••---•--•-------•........----..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en�sueyard f health. Signed �`� ---- ---------------- �'./.2 0./..9.4......... Dace Application Approved BY - _ .. +„-...-��.. ...... ... �� Application Disapproved for the �010wingreafons: ....... ............. . ................................................--------------------------------- .......... .............. ................. ......... .. ........_.............._._------.----- ......._......--------------------------------------. ---------------------------------------- C� 3 Permit No. ......7....Lj...-..... ................... Issued - .......................... - ......Dare............ Dare No...... ..._1..1..3 = FE:B.....$....30..00 THE COMMONWEALTH OF MASSACHUSETTS O 3 8� � v �- BOARD OF HEALTH ` TOWN OF BARNSTABLE 4 24 Appliratiun for Bitjipnml Workii Tontitrur#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair gX)r an Individual Sewage Disposal System at: • 124 Captain Carltons Road Cotuit ..........................•--•-••---• .. . ..•-- ••-------....------------•--..._....... .-•----------•-•----•--••-----•-•-•-----••- --- ---•••------•---•----•--.........--•---•-- Location-Address or Lot No. Emir Smaykiewicz .................._.......................................................................... --------------------------------...........------------.....----.........---•--•........--------- Owner Address W J.P.Macomber Jr. a ---------•---•••--•------------------------•-----------------------------------•--------- --------------------------------------•------•--------.....-••....------•---...................--- Installer Address UType of Building Size Lot............................Sq. feet .. Dwelling No. of Bedrooms.............3-----------------------------Expansion Attic ( ) Garbage-Grinder ( ) aOther—Type of Building ____________________________ No. of persons........ .__------__,__---_ Showers ( ) — Cafeteria ( ) Other fixtures . - -.--------•---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow-.-.----------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width-----__-..__-___ Diameter---------------- Depth..............- Disposal Trench—No. .................... Width:..........._..._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------------------------------------------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------------ .................................................................................................................................... 0 Description of Soil............................................................................................Sand.... x W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable...-_AA r3-__ad ci i_o-n_a 1.._.-- ... n._. _existinq.__tank._.& oit. ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . 4/20/94 . fj Dare Application Approved By ..............Tolow ..../. e �e �f Application Disapproved for theing reasons: .. ( 3 Permit No. ......1..L ` ............................. Issued .......-...-..-...... Date -------- --------------- -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 101-Ertifirate of Q-1-amplianre t THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired�XX ) b --- y J.P.Macomber Jr. ----------------------- ------------------------------------------------------------------------------------------ ------ Installer 124 Captain Carltons Road Cotuit at .... ........ ........._............._._........... .. . .... - .... - .......... - - has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -_.. - .`_../.,?-�.......... dated ...._ ----------- ------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- ...f....��------------ - Inspector- ... - -------_------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 30 00 FEE........... .....------ �i��u�ttl urk� �un;��r�r#iuri �rrmit J P Macomber Jr. Permissionis hereby granted.............---------------------------------------------------------------------------------------------------•-----.....•----..--•••...... to Construct ( ) or Repair N.rlt ) an Individual Sewage Disposal System 124 Captain ons Road Cotuit -at No... ..... • • -- --------- -------•--- . . Street J _ as shown on the application for Disposal Works Construction Permit No. .3� 3. Dated...... �..Ll........ ______ _ �� C✓ t �, Board of Health DATE......... ? •". ................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS �-. m !" 0 {tour£� )-Z4 f.7 7 LSO A T 1bNn S E A G E� PERMIT NO. V- ,L l A G E I N S T LLER NAME D ADDRESS �oh�/) '!' , "C, D U,I l D E R OR O N ER no l cp 4 '/Cg- f� " `L DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ', �c A 1 L No................-./......r Fms. 'L...`.r. ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH I ,T .....---...--- .........OF.......... A �...:...... .............................................. /�- Appliraa#ion fur ilispnaaal orko Tvautrurtinn amit /�K Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sew ge Disposal � System a l � ... - _ ... _ ...._... ................................. _.. ----------------• P �o ation Address or Lot No . ................... ................. . .. �. _._,r... .........--- ... r.. ' l..-........ Address �CZ W J4 ���................... / .........._ a Installer Us ,Type of Building Size Lot _ .�5t 6Jv.......Sq. feet U Dwelling—No. of Bedrooms........�...............................Expansion Attic ( —j— Garbage Grinder kV� Other—Type e of Building No. of persons............................ Showers G� yP g --------•------------------- P ( ) — Cafeteria ( ) Q' Other fixtures -----••-•-------------------------------------••-- . W Design Flow...3-3.Q------------------------------gallons per person per day. Total daily flow.-S87...............................gallons. WSeptic Ta Liquid capacity..IPO.gallons Length... .......... Width....�Y._........ Diameter.........._.....Pepth................ Disposal —" ...........• Width T................. Total Length.................... Total leaching aiea_i!......__...sq. ft. :v o Seepage Pit No.........I---------- Diameter.._............. Depth below inlet...-•............ Total leaching area..................sq. ft. Z Other Distribution box (� ) Dosin tank ) '-' Percolation Test Resul Performed by-. .,r�!1.. .._.. ss _ r S-- l�Gl� ll / /� a Date_.....-•----...... --..y---- ,.a Test Pit No. l Z4---__-minutes per inch Depth of Test Pit._/Yy........ Depth to ground water..--...__.......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .................. .. . . .,11. . . ....... ---- ------- O Description of S -- oil -- - 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 TITLE 5 of the State Sanitary Cod — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ed b eA of i lth.4 °'� 4 Signed ........................... /n_a./.._._._.. ate Application Approved BY l d... 27--7�_--- ......................... ... . Date Application Disapproved for the following reasons----------------•-----------••-------------------------------•--------------------------.._......•••---....----- ....................................................................................................................................................................................................... 7 Date PermitNo......................................................... Issued---- `- ...................... Date t J y)No................. - JpGfr-.1 TER......................... ~~ THE COMMONWEALTH OF MASSACHUSETTS J. ;2. . BOARD OF HEALTH r:. F Apli1uttiion fur.,0itwosFa1 Works Tontrurtion Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sew ge Disposal System op -:- ram_. .......................... ............... .......... Q ... ...... tion"*Address . or Lot No. G .Atlho....�`�................... ..... �e�_...,�+�'�f. ....!8., ............ Address Installer Type of Building Size Lot. f 000 ...._Sq. feet Dwelling—No. of Bedrooms.__........................... Expansion Attic ( Garbage Grinder (4-44 aOther Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------=----•-••--•;-----------.......-- W Design Flow.__; gallons per per' er da Total dailyflow---. ��.................................... • Ions. WSeptic Tan —` iquid capacity._� gall'ons Length____ __________ Width._..,l�__....... Diameter................ Depth................ Disposal ..._..... .... Width__________________ Total Length...........__ Total leaching area..--!.........sq. ft. Seepage Pit No...._..__I._...._.. Diameter..4.._......, Depth below inlet...... ........... Total leaching area..................sq. ft. ( ) ` ) , ,, Other Distribution box Dosin tank d Percolation Test Result Performed by.... _.:fs ! ,� ate 1 Test Pit No :L_..+ _.minutesTper inch Depth of Test Pit...1 ..... Depth to ground water °�� � Test Pit No. 2...:............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------x t Description of Soil-->d � _...' :... �Cr !`..c ;1;.=............... -0........ yg..••--••--••-----•-._•---------------------------------------•-•--•-----•••-•-••-•-•---•---•-••--••--••-.................................... ---------•-•-•--•------•--........•-••••----•---•-------•............. U Nature of Repairs or'Aiterations—Answer when applicable..................:.................................................:............................ ----------------------=-------------------------•--•----•--•---•----•--..._•-•-•--•-.....-•--.--_...--•--•-----•--•--•--------•----•-------•••••-•••----•--------•......._........_........_...........: Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal. System in accordance with the provisions of TITLE, 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 ' ed Wbyeeiof 1th.,, g .. ................... ., /at;e Application Approved BY '' -- ---• •---__ . ....................... - �t!f ....................... j Date IApplication Disapproved for the following reasons:................,.------••--•---•-•---------------•-------...---------------....---------- --•--•----•----...- ......._______________________________________________________ ________Nti....{_.u._...._.......___...._.... Date Permit No.................. Issued---------------• -----------------•---•------_._... Date THE COMMONWEALTH OF MASSACHUSETTS t�,,�.+ BOARb"OF' HEALTH . !"'w�1C ±''1...........OF......... . .0.4- 4..+.............................................. Trrt' irate of ToutpliFanrr THIS I 0 CE I Y, hat t ndividual Sewage Disposal System constructed ( Repaired ( ) by.......... ------------------ •-• = at ..`t.... I....... = (Jtler r _--.fi� .+Y ]� r - ------ ..... ._ _ •_ •._. ...._ _ _________ f V7 < -. has been installed in accordance with lie provisions of TI j of The State Sanitary" ode as described in the application for Disposal Works Construction Permit No.... °___' '" ._____. dated------fry''__. . - .......... THE ISSUi4NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEk, WILL FUNCTION SATISFACTORY. DATE............................• ................... Inspector..................... THE COMMONWEALTH-0-F—M-ASSAC-H=USETTS.-1� BOARD OF HEALTH � .....-.....OF...... ... -.sr: ..:........................................... . No ...... ... FEE.... ... ~......... 140pos al ork n #r ' n unfit Permission is hereby granted--- --• • . ... .. .........•------...........-----..........----•...................._.... to Constru t ( ror Repair ,( ,�,�n ndividual Sewage'Dis,P`��sal S tem' �y , at Na_.-r dr-=- •� ?:. .._�C -. .. ......... Street y as shown on the application for Disposal Works Construction Perm o ated "..2 7 `Vf ...... ..... ..... ... -P� ..._. Board of Health DATE...... "���. t. FORM 1255, HOBBS A& WARREN. INC.. PUBLISHERS p ° Of tit IN � Ga-:� a �St�*-� -. �•' CG��'{ �� .' rC•OfJNDti`T'/Or✓ r,g•� ,t• b too(? /�SGf1 Shy /d1C .Strl! r I J f �' ' " ""_ .ref/.�✓. ya :s �/ u /fz tar - ;e C R,01�ACC ,//1� ------ s L�_ . _ �1 0 L E 1''d�Q+���+'`j►fj�p. 7"" sORc31Q'c� AO s. ,A.// 7�--�,,ey �is,�os A� s ys � 3 � �yA L orv�`o�t 7-0 ,-, , . \ �L 1140 r7'T�Z�=„%� SITE PLAN SHOWING" RR POS D CONSTRUCTION ' a�} SCALE : / — DATE 9 BOARD OF HEALTH RE` FFRENCE� . .. Q ATE ,AGE° r OF KH. a i3aacitt .�8 , C S A S S 0 C i A'T E S, 1 fed C . Ss I9�sp C,� EGlSTCREa 'ENGINEERS G ,LANID SURVEYORS t r, �5�� .;t���•� i 1i7• Ia P E of-'FICE BUILDING �• t2t3� RatITE � 8 � #.. Pam. s .. :s.• r 0 U T H Y A R M 0 U T H, W A 5S. ,!, 00