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HomeMy WebLinkAbout0041 CURLEW WAY - Health , " Al Curiew ,Way + k Cotutit's t 1 I 19 D Lttle River Road Cotuit A= 054— 006 - 001 A 1 I - Commonwealth of Massachusetts b - Dos W Title 5 P;aage icial Inspection Form Subsurface SyDisposal System Form -Not for Voluntary Assessments M 41 Curlew-8t: Cotuit, MA 02635 ' Property Address N"' P-t Sean &Christine Benn_ers 48 Eagle Dr. Owner Owner s Name information is a�:5 required for every Mashpee MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return Name of Inspector key. P Cape Cod Septic Services Company Name 350 Main St Company Address �fm W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 SI5016 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 7/12/2018 I Spector's Signature Date 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. ****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. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title N w 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 Property Address Sean &Christine Benners 48 Eagle Dr. Owner Owner's Name information is ee Mash required for every p MA 02649 7/2/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments sy0,r 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owners Name information is ee Mash required for every p MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont:) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed. ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owners Name information is required for eve Mash ee every - MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® 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 '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °7M 41 Curlew St. Cotuit, MA 02635 Property Address Sean &Christine Benners 48 Eagle Dr. Owner Owners Name information is ee Mash required for every p MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection B. Certification (co nt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ - ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what.will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts w Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4c b a'°t 41 Curlew St. Cotuit, MA 02635 Property Address Sean &Christine Benners 48 Eagle Dr. Owner Owner's Name information is required.for every Mashpee MA 02649 7/2/2018 page. Cltylrown 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 ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened; and the interior of the tank. inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System.Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110x3= 330gpd t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts �u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owner's Name information is Mash required for every pee MA 02649 7/2/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2016=121gpd Detail: 2017=118gpd Sump pump? ❑ Yes ® No Last date of occupancy: May 2018 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): ° Gallons per day(gpd) , Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title .5 Official Inspection Form X Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owner's Name information is required for every Mashpee MA 02649 7/2/2018 page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments V0'e. 41 Curlew St. Cotuit, MA 02635 Property Address Sean &Christine Benners 48 Eagle Dr. Owner Owner's Name information is P MBSh e required for every e MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1994 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3011 feet Material-of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 20" feet Material of construction: ®concrete ❑ 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: 1500Ga1 Sludge depth: 6-8" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts A Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Berliners 48 Eagle Dr. Owner Owners Name information is required for every Mashpee MA 02649 7/2/2018 page. City/Town State Zip Code. Dated Inspection D. System Information(cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 3-51' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good structural condition. PVC tees in place. Tank at normal operating level. Covers 20" below grade. Recommend service of tank. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owner's Name information is ee Mash required for every p MA 02649 7/2/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information tlon (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments.(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments ^M 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owners Name information is required for every Mashpee MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 01. 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.): H-10 DB-3 with 1 line in and 1 line out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 30" below grade. Pump Chamber(locate on site plan): Pumps in working order. ❑ _Yes ❑ No` Alarms in working order: El Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 12 of 17 Commonwealth.of Massachusetts - W Title 5 Official Inspection Form a o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 M SvOye Property Address Sean & Christine Benners 48 Eagle Dr. Owner -Owner's Name information is Ow required for every Mashpee MA 02649 7/2/2018 page. City/Town State Zip Code Date of,lnspection D. System Information (cont.) Type: ® leaching pits number: 1-64 ❑ 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.): 1-6x6 Pit with 2'of stone. 1'of effluent in pit at time of inspection. No eviddent staining. No sign of overloading or hydraulic failure. Cover 16" below grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntar y Assessments 41 Curlew St. Cotuit, MA 02635 6Vey`v Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owners Name information is required for every Mashpee MA 02649 7/2/2018 page. Cityrrown State Zip Code -Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official.Inspection Fonn:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 41 Curlew St. Cotuit, MA 02635 Property Address Sean &Christine Benners 48 Eagle Dr. Owner Owners Name information is ee Mash required for every p MA 02649 7/2/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Curlew St. Cotuit, MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owner's Name information is ee Mash required for every p MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +13' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health explain: ❑ Checked with local excavators, installers,-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand auger did not encounter water at 13'. Max bottom of leaching is 9' Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° ,•°°� 41 Curlew St. Cotuit,'MA 02635 Property Address Sean & Christine Benners 48 Eagle Dr. Owner Owner's Name information is required for every Mash pee MA 02649 7/2/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C. D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r � t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-.Page 17 of 17 TOWN OF BARNSTABLE �' � ° SEWAGE # 9y_ �' LOCATION' i.r�2Lr� Gi�Q•G� 7 / VILLAGE .t�Oy��i'� ASSESSOR'S MAP & LOTOa�/- DES INSTALLER'S.NAME & PHONE .�lC.0 NO1"k1W ag?*d SEPTIC TANK CAPACITY /000 09//d/2 ~LEACHING FACILITY:{type)4 6J aize �- ' NO. OF BEDROObIS _PRIVATE WELL O PUBLIC WA TER ' UILDE� O OWNER) s' ' h r/ J?ID DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: !, VARIANCE GRANTED: Yes o t t� LIP J TOWN OF BARNSTABLE LOCATION'j�� ,r.���� � �� SEWAGE # VILLAGE L Q y f�pL ASSESSOR'S MAP & LOTOc2�/- 9 d � INSTALLER'S NAME PHONE NO. /I I (2oo S V. YOff- SEPTIC TANK CAPACITY /0,00 Q / LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER�� UILDE; O OWNI DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED "° , VARIANCE GRANTED: Yes No Ll 4l ' ��--� c p L{ No...?V*..:. 7 /8.j3....... rn �/ THE COMMONWEALTH OF MASSACHUSETTS 7Vj BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiutt for Diipugttl Works Cnunitrurt"tun 1hrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ...41...(?L./)4.:&k..wR?.4 CCc�rv_(T.. ... ss S� �j .. ...........�s.... Loattion/\ddre r Lot No. 1..'�.. �E..l�!`tfJPrhl-h .�3v1L1� ....... .......r`'t �Z----------.......�l tc t s;..H4:..--------.........---......--- rrDNs Owner L 6� Address �1.4 Installer Address d Type of Building ? Size Lot,., /__044A...Sq. feet Dwell Grinder 04 Other ing Typeoof Buildingn,s-------------J-------. No. of persons nsion Attic.�•....)Showers (C,ajbageCafeter a ( ) a' Other fixtures ...................................................... W Design Flow.............../Lo...................gallons per person per day. Total daily flow......--.- .l.a...................._gallons. 9 Septic Tank—Liquid capacityl!?�,?°gallons Width--4/__Db... Diameter... ............ Depth.._felp..... Disposal Trench--No. .................... Width.................... Total Length................... Total leaching area....................sq. ft. Seepage Pit No...... ............ Diameter-_--.�!?..`...-. Depth below inlet-..s .SO.._.. Total leaching area..2S/�.�.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.-. W,f rp C E._:...... Date.... J.. n.-V..... ,aa Test Pit No. I.....:?--.-minutes per inch Depth of Test Pit-----f.......... Depth to ground water---P0.1............. Test Pit No. 2........7—...minutes per inch Depth of Test Pit----&.'........ Depth to ground water... 0f.............. P+ •----------------------------------•----...--------------•-•---•-•-......................................................................................... 0 Description of Soil........................................................................................................................................................................ x U ---------------•------•----............................................................................................................................................................................ 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s b en issue y t oard of health. Signed ......... ................................. ........._............................................... ......19 j� .... Date Application Approved By --------- ... Date Application Disapproved for the ollowing reasons.* ........ .......... ................................................................................................................ ...... ................................................................. ................................. q, Date Permit No. ,.�.-:..-1. ..7--------- --------------- Issued .............................. Dare V J-'-� No.... ..:..N 7A Fps...... % .. ....... n �r✓ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE .���lirttti>a�t�fur �1i���u�u1 �urlt,� Cnuat��rnr�"tun rrutit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at: ------------ SS�ss �I.. 1�t __ y::�. o Location-:lddrr s /2 s,/D� - ---or Lot No. ..JUEf1�_r�t� e �_ /�'h Mic[s.!`'t ................................. ------ ------ ---------------- Owner Address w 1�0/L•TDLo_77'�.. rOA' S77Zc!4-71VAJ ,� ------------------- ----- -------------------------------------------------------------------------------------------------- � Installer Address Type of Building _ Size Lot..2v _no.9...Sq. feet U Dwelling—No. of Bedrooms..............3......_...__..._-_-_-...Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------------------------------------------------------------------------------•...............-••--••--•-••-------••--....----•-------•---•---•---. W Design Flow............... Q...................gallons per person per day. Total daily flow.......... .....................gallons. WSeptic Tank—Liquid capacity Zed°gallons Length..9.'�..". Width..4/.2D.... Diameter................ Depth...!Kk.r�.. x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....../........---- Diameter..... Depth below inlet.... .... Total leaching area.. ft. Z Other Distribution box ( X) Dosing tank ( ) � Percolation Test Results Performed by �!/A2r�-._ .rf :��' f2..OF.._._ Date..... 1._��2..9'1..... 0-1 Test Pit No. I...... .-..minutes per inch Depth of Test Pit..... (........... Depth to ground water..-��............. (i, Test 'Pit No. 2......2...minutes per inch Depth of Test Pit....16.......... Depth to ground water..AK............. 9 I1.,,, ----------------------------------------•------------------•---....------........••••-••••................................................................... 0 Description of Soil.......................................................................................................................................................................... W V -------------------------------------------- ------------------ •--•-------------- .--.---------------------------------- ••--•-------------------------------------- ..._......... .•---.---.---------•- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•.................-•----•--•-----------••--••-••-•-••-........•-••-•--•-•••--•------••-------•••-•......-•••-•-••-----••-•-••-------•--••---•-•-----........-----•-•-•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b9een issued y the-board of health. Signed ---------���L ............... .... ........................................ / Dare ApplicationApproved By ............... .. ......... ..... f.....................................-.-............................. ......... .-�... Application Disapproved for the ollowing rearonr: --.._................................... ..... _........--`.. ................................--...---.................. ...... ...........................................................................................................................•.�.................................................. q - \ Dace PermitNo. / -... .y.. ........................... Issued .......................................................... . .... Dace THE COMMONWEALTH OF MASSACHUSETTS���w���'��`—�<_.�....,._.._,_._,.�,._,�.�,..a_.�.�__ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance I THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................... ( - . 1 - . ...--..-.........-.-_............ _... ...................... .....aue .................. ....... at -------. ..../......_...... . .......... {1 ----.---------*.....-. ..... ..-....-........-......-_............................................. - ..... has been installed in accordance with the Ar visions of TITLE 5C?4_The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...-... - ..-.-..L--//..7..... dated ......................................_..._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................ .' -- .." .. .. Inspector . .......................... ........................I.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE / No.. '.Lf .. FFE....1.0.0....... Uispoal Workv Tnni#r ion ��ermit Permission is hereby granted............/P�` '�k ..................................... ...................................................... to Construct`(-) or Repair ( ) an Individual Sewage Disposal S stem - -.--- Street as shown on the application for Disposal Works Construction Permit o.� -.� .Dated........ -'—/.... ....... -•---•---•-V s ------ \ -.•------------------------------- Board of Health DATE.............. " c7... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS SCALE 1 :30 sow t�F aMT)A7rOO SST 10L-krie?em r_-Q kY j5uAP,6 S�PZr� ' ;V)/K (No Z, Pry P, .� av 31 MAR q4 wvxlrtzs so �y MR• pr-s�N Fux,4/ � A��4�= x //Ddrv�/AAy 4PE DWAgg BA RR.Y B A RN�S_P LE 8,Me, of fYr1V_TN 110 &&/ >, L 0 T 9 PjGRG sT PER MED ev kDWt\RD L 0 T 10 � . �3Z� __ ,- -�- /1�:.z✓V/1icY f�- � Gg (l PA = �^ /�_ /ulxwb) En��'� Pn� MNr 53 TbP t SUB _ 53,7 r� i' y Tom+ sum , .�wp�� �� � 2Ti''h h (2. czar-/FT Z) q0 PENCA/ RK CURLEW / r V A I P-K NAILA 2N PAVEM� 'iDN/N W — ? — — - / SILT Y — �S' 3 5� 2`1 r (S) (5s) (2,S) - q3Z GAL 1`I- sv.oz' N w1k aR �L Y Z U-AY - -W - - - - - -�G _�/�/ ' i 5 pb`� 3 W IL CLAY _ SI.2`/ - - - - - '�' rZ I o rw-/FTZ) - -o-u. N s 3 y 1N -o- u o, - - - - ---�i M�4. S ANC Z p PE�.c �UT1'D► /� +'� ( 7 ' EGgST ID 1 cFW� Mt✓D• � Zi w/Sow 6V ='1 // t S, 1•�� ! 1 CAL- ,�� - - - - Prr Gf+� 1� WpTEP Tlv,k Zs TP9 ti0 TP2 (�E M 1 dT b- , 16 TD T A L AREA I� l�A9 i 67 ZSI. S FTz w °� � 10 10MIN BDX ME�U(m FINE L 0 T 17 `� , 53,2�/ 'y 4 , � SFD 6y'* \ L 0 T 15 TO SAND O X (r, 2Y 3 flgppcoM — FZNJ� House st y► a N 5,P ID N o Z N x sy o w I_R 53,5d z S,+ y T \ LOT 16 Construction of this proposed septic system shall be in confozm a.i.ce with �3 20,00C r- z 37 6 Title 5 of the MA Sanitary Code. An as-built certification is required prior to backf ill . 2 . No changes are to be made to this plan or design without .approval of the 1- Board of Health and the Design Engineer. 3 . The contractor is responsible to ensure that the septic system is constructed as per the design herein and location indicated. L 0 T 21 4; The septic tank should be checked annually and pumped as required. PLAN REFERENCE PLAN BczaK j9q P, S 1 (bEeD : Nq 3/�Z7 ASSESSORS REFERENCE : MaP ay , PAPCF_L- ` Y-5 c �. ww A iP+ • (�iJ. des Certification of this drawing is not valid unless 51•q I Z !` 5 ° u a 2,3 ± the stamp above is provided in red ink. P PVG ' Flow �. e d ,Q Q, a ,. ,Q.4 'c�'Day �' 1/l/ 117 S-,oz 10 a s-,OZ 6" 0 © 0 a , f Sb, y,r ,Yo 0 0 00 Q - - 4 PVC, Pik a O 000 3y„_��'2� PROPOSED SEPTIC SYSTEM 41 CURLEW WAY COTUIT, MA r (OR DIsT iT so, s'a 0 0 0 WASN D t R: �"r�s. PREPARE F MR• �� VAUCI��,II o 0O007 VAUGN N HOME BYELUEPS 0100 00 MARSX0P5 AAxQ-S lei Q 00 0 o z r -r-I PESCE ENGINEERING'G SSCIA,TS oPMG PR ) LANE, LE T Y 3 0 L , OS ER ILLE, MA 02655 PHONE. 508-428 373