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HomeMy WebLinkAbout0011 EAGLESTONE WAY - Health I AGLESTON E WAY 054-009-001 COTUIT i i�' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary'Assessments M 11 EAGLESTONE Property Address TALMA Owner Owners Name information is required for COTUIT MA 2/27/13 i 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. Please see completeness checklist at the end.of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 �d01 Cityrrown State Zip Code 508-420-4534 S14297 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 2/27/13 Insp ors 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. r 4 ****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. j/' 15M t5ins•11/10 Title 5 aci Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 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: SYSTEM MEETS PASSING REQUIREMENTS AT TIME OF INSPECTION B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT - MA 2/27/13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. 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•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 11 EAGLESTONE Property Address TALMA Owner Owners Name information is required for COTUIT MA 2/27/13 every page. Citylrown 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 Y2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments °M 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® ¢Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ E. 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.] ❑ 0 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#eet of a tributary to a surface drinking water supply` the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ El Area—IWPA)or a mapped Zone Il 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of'Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °,M 5 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. City/Town 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 El ® 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 recent) or as art of ❑ ® 9 Y Y P 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 breakout? ❑ Z 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? El ® 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. El Z 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r'� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Cityfrown State Zip Code Date of Inspection D. System Information _ Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 2 6X10 PITS Number of current residents Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected?. ❑' Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail { 2011----------298 2012------------306 ' Sump,pump? ❑ Yes ❑ No n Last date of occupancy: • Date Commercial/industrial Flow Conditions: ' Type of Establishment: s 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? t ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts v Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 EAGLESTONE Property Address . TALMA Owner Owner's Name . information is COTUIT MA 2/27/13 required for every 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: 1990 OFF AS-BUILT Were sewage odors detected when arriving at the site? 4 ❑ Yes ® No Building Sewer(locate on site plan): Depth below,grade: ' feet Material of construction: ❑ cast-iron ❑ 40 PVC ❑ other(explain), Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): y Septic Tank(locate on site plan): e Depth:below grade: .' 1.5- feet Material of construction: ®concrete ❑ metal ❑fiberglass Elpolyethylene ❑ other(explain) If tank is metal, list age: ti years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1500 Dimensions: LIGHT/VARYING Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. City/Town State Zip Code Date of Inspection D. System Information (conf.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle-- Scum thickness TRACE 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? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P P P ) ( P ) Depth below grade: . , Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 111 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - �M , 11 EAGLESTONE Property Address y TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.): BOX LEVEL NO SIGNS OF FAILURE Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms.in working order: ❑ Yes ❑ No 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: . t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) Type: ® leaching pits number: 2 ❑ 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.): ONE PIT WAS OPENED AND FOUND TO BE EMPTY WITH NO SIGNS OF FAILURE AT TIME OF INSPECTION, STAINING WAS HARD TO DETERMINE DU TO DEPTH OF PIT BUT THERE WERE NO SIGNS OF FAILURE Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth - top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 EAGLESTONE Property Address TALMA Owner Owner's Name ' information is required for COTUIT MA 2/27/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids . Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):' t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 117 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every 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: AT LEAST 5 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: ASKED INSTALLER HE SAID THE PROPERTY IS HIGH AND THEY DIDNT ENCOUNTER ANY WATER t - Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System:Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 11 EAGLESTONE Property Address TALMA Owner Owner's Name information is required for COTUIT MA 2/27/13 every page. Cityfrown 'State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 1 " OWN Ole.BARNSTABLE LOCATION L v SEWhGE �-=— VILL AGE C,24 p - _ ASSESSOR'S MAP LOT IJ�J -WM &INSTALLER'S NAME & PHONE NO. .�or. ,, � l �-�:. � Lq a8-aSQS , ZSEPTIC TANK CAPACITY 1`�Op �QI(e1s LEACH= FACILITY:(type) Z — PITS (size) 6 x_ 10 <NO.OF BEDROOMS_4-( PRIVATE WELL O UALIC WATER Pc.,B�iL d BUILDER OR OWNER k\/( LL— DATE PERMIT ISSUED: 6 1 1- 90 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r 5 http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar--054009001&seq=1 3/7/2013 co 7 . 00 l qq �r No,e THE COMMONWEALTH OF MASSACHUSETTS ��EOARD OF HEALTH ./i ...........OF..... .7X d� ............................ Appliration for %gpoaa1 Workii Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct (V<or Repair ( ) an Individual Sewage Disposal System at: .......... 1A1 Pg�(a..6-t;! .................................. ....................................... Location.Address or Lot No. "-----•------------•----•. e'er 01 � ' ..�`-' A........................................... w er Address ............................. ._.....---- Installer Address � d Type of Building [ Size Lot..�7t_1 ...Sq. feet U Dwelling—No. of Bedrooms...............7-_._-___--•:._______•___Expansion Attic ( ) Garbage Grinder (✓f '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a 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......./0..... Depth below inlet_...._�........ Total leaching area..Z3./._sq. ft. Other Distribution box (V� Dosing tank ( ) Percolation Test Results Performed by._..... X`P �_'�__t�r __��_...... Date-__- _�Z7_'90........_.. a Test Pit No. I.....r�___-__-_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........................ -------------------------------•--•--•••--••-----•-.•.-- --•••--•--------------•-..._.........-----•------•----------•--------•---•-••-----•----•----•--•••. O I� CY `me� /J_ Description of Soil -----� .............. ... -•--------------•-••-••-----•-••-••--•....----•-•---••......---------...._.. x ......,�_r./0---•-••.� 1V1V---- '1�. .................................................................... 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 iIT .;,;. p 5 of the State Sanitary Code— The undersigned further agrees not to place the system In operation until ertificate of Compliance has been issu d by the bo rd of health. . d f �[ - Sign .--•• `,-- 7 e71�— Dat A/pp`lication Approved By---••---•-••-���--`- ... ................ Date Application Disapproved for the following reasons------------------------•--------------------------------------------------------------------•---•••-----•••----- _........--•------••--•-•----•-•--•-•--•------------•--•-----•-----•----•-----••--•----------•-------•--•------••---•----•-•------•----•••-••---••-•----•---------------•-----•---•--------•-----•------ q Date PermitNo.----1...m�'.'.. ......................... Issued........................................................ Date r r.. Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - -Gl...f-..........OF.... � f ------------•-----•----------- ApVliratiou for Disposal Works Cnnnutrurtinn "truth Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal System_ at,: - Location-Address or or Lot No. t'V`w,�. �� ....... .. � ........................................ caner - Address Installer Address Q Type of.Building Size Lot... _ .f��__._Sq. feet U Dwelling—No. of Bedrooms.-•---•---•---�........................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures ----------------------•----- --------------•-----•---•-••-•-••--•-------•-••--••••••---•-------•-•-•- W Design Flow______________�__ ________________________gallons per person per day. Total daily flow__.______." _________.._..__._gallons. WSeptic Tank—Liquid capacit/d:'?d__gallons Length................ Width................ Diameter.........._..... Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_._..___________ sq. ft. Seepage Pit No........ ------__ Diameter._____ 4'______ Depth below inlet___._4'......... Total leaching area_ sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-_._._�<#�:_:'�_J_- y�f-_.. 3=_-______ Date___ 2-7—90 ,aa Test Pit No. I..... .......minutes per inch Depth of Test Pit......__.~_______ Depth to ground water_____"""-__________- G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------------------------- -....................................................................................................................... D Description of Soil..........................42--"...e�--------....e..... . ..._..._._` 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 LITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation untill.a Certificate of Compliance has been issued by the board of health. l.. Signed 3 ar ... rr _ .> Date Application Approved.BY - `'......... r`,t r t . ,. -- J Date Application Disapproved for the following reasons---------------------•---------------•--------------•---------------------------•--------------------------•--•- ....-•---•----••.............•-•-------------._._.....------....----------•-------------------------..................... -----------------••---------------------------------------------._...._._ Date PermitNo..- - -` f?--•-•----•-•-•-•--•------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,,.... BOARD OF HEALTH �-- ...._......1.. ..........OF.......1,��" 0g .�� -7?G� -?� ....................... QCrrfifiratr of Tnutpliunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (y) or Repaired ( ) by _,4_ Installer at......... ==r' �•..... C`2�. s�� C.1�f:_. I�, -C: t, / rs�l !_t t ............................................................... .... . •--....... ----- - -.._.....1---�-- has been installed in accordariee with the provisions of TIm'F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.....�cA_:__..-_2._.7______._.__ dated................................_............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................f....---•3...... - ------•--••---- Inspector.............. .:.s --------.......................................... 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l'_ ) OF..... - 3 f d I.... C FEE...!.�..��.......... Disposal Works T.unutr ion rrutit � t .... Permission is hereby granted......... - =-•--•-•C��f �'J to Construct (t<) or Repair ( ) an Individual Sewage Disposal System at No f.. • " � ...... i(l cr,1a . ,r...{..., 1 .�- 1,-1 C� Street t as shown on the application for Disposal Works Construction Permit.No,_5'__::� ?____ Dated.......................................... _______ Board of`Health DATE......... {I FORM 1255 HOBBS & WARREN, INC., PUBLISHERS s �JE516 N w'-PA7A '.:? �":�l,/1t'�•: IaA�AC�E GRItJ�7E� 44p �'?D C. TANS 4-4 xSoo� : .'eeD�'P? ' D15?oSAL_- PITS �-"l�ooGQ���y' s 51DEW4LL SF TO�Jir SEE P-Ai , o/J r3AuL NL- -or- 220 5F X 2•.S_ 55t��PD �. F' BvTT�M A2fAs-i s L oT 'Z T L- 16EJ - .��� ' CDTU IT M�- ` 'TOtAL VA 1U =440 6PD 'b Ce- + r PEP.�DC.ATtoN : r NOF P;TER FcNRFD v SULLIVAN BWER 9 TF 9•S . ::. .. suaso►L _ V. P ST _ . ru✓ GAL �, S iuJ ( ep 3} Leo l6JJ �41sl 5.q TA N Z is ML l 42 ^ s 1 . � P i. go IO #' OTEZ ,G Gl1 �- C �I 6EP-TIFY AT T► S D L�u�, PLAN R :. c QWfJ HEzwtj <::DM'PAS .wltµ TuF-' �e7 IL 15 •, �. �. : 07'(O CQf . VA u TAE SOD mAlill , �l � L5 , `lama. 115 IS Not" 13AS© oN hN; MllS v�tVr z��i L E+J61 N EGL5 : ._i 5u�✓cY ' MD_ TNT ..PWF e1 44tiu�. 0Ur 'a2 o5'('Erzvtt MA44 , is use To :E5TQ8LI5� �Pr�E�Ty u Nc-5 dpptrtcQN T' W IL. L C-U&2.1T- DrE I # . ET �AAP ?r_L 1.04-97 4 4, o4 � � � N 3 : t T _ _ LAP- P a t i � poop 4 _ _...._ _ ... S Or e ; \j ,ti Ls PETER SULLIVAN eaxrFR w _.. _._.. Flo- 29733 \ !, TOWN OP EARNSTABLE I.00;ATIO1i SEWAGE # ' VILLAGE_ ASSESSOR'S MAP St LOT .06�0'00kj �INS'IALLER'S NAME Sa PHONE NO. A aki I) � y as -9SQS , ZSEPTIC TANK CAPACITY 1`a00 c,a0,")5 ° LEACH114G FACILITYAtyne)_ 2. — (sire) 6 x 10 <NO. OF BEDROOMS PRIVATE WELL OR UBLIC WATER Ru&_j _ BUILDER OR OWNER_ \\/I 177 DATE PERMIT ISSUED: 6 — ! I- 90 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No � ��\�� �� � \ \ � �t� � � \�. ��\� � � � � � -, �� �` � , � � f .� --.�..� .. �� ��`. ����� � f ASSESSORS MAP NO: PARCEL NO: d� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for liiipnoa1 Workii (fin i rnrfiun Prrutit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: \fJA-< --... t,,.ry_ .._ •--- . -------------------------•-----....... ---............-------•--- -----------........._......__..._.....---- Location-Address or Lot No. tAlll.l M��y 1�V�2+ `�T ®t' - ......................- --- --.. ............................................................ •.. ••. ,-- Owner Address �ki.� IJ�IR �AI&)E- MA2KS��:V�. tulus� ✓rIA� a •-----------------------•--••-••-----•------._....___----•-..._____......•.........._......•_•__-. .........................................t.............................f-•••......•--•i........... M Installer Address U Type of Building Size Lot__A53.37 ----Sq. feet Dwelling—No. of Bedrooms_______ __________________________________Expansion Attic NO) Garbage Grinder (\k-)5 'k Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures ____________________________ _ ----------------------------- ------------------------••--------------------- W Design Flow___________ S .......gallons per person per day. Total daily flow______�fit ________________________gallons. WSeptic Tank—Liquid capacity_t allons Length_1Q_-w._ Width__t:_.'AS___ Diameter__^______ Depth___ .'_ca x Disposal Trench—No_____________________ Width_..._1____._._______ Total Length.................... Total leaching area....................sq. ft. Seepage. Pit No.______Z......... Diameter__._.1 --------- Depth below inlet....6........... Total leaching area._5_5 ..... ft. Z Other Distribution box Ve� Dosing tank NO) `-' Percolation Test Results Performed by--- .... ........... Date__ /_ `/90......... W ,.a Test Pit No. L_Z�-____minutes per inch Depth of Test Pit.....1Q......... Depth to ground Gr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ..................................! --•------------•-•-----------......._....._.__...••......................................................... xDescription of Soil--....O."A... M s'' 1 L. ... V>.....!� V ..............................................•-•---•-------......................................•-----•----•-•--------------•-•••-•-----------------•--------•••------......---•-------------------- W VNature 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 been issued by the board of health. Signed <o Application Approved By .......................................................... �............................. 9v ------ '--......................"---'---...--.-----..-.-...------..--..---....- Date Application Disapproved for the following reasons: '•...............'--------------''---------------------------................... ............................................ - - - ------------------------- ----------------------------------------------------------- -------------------- ' Date Permit No: ��. ...........� Issued ------------------ Date O No----------------_42_ 41 r Fps......0 0__ v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dispusttl Vurks Tunstrurtiun Permit Application is hereby made for a Permit to Construct (u) or Repair ( ) an Individual Sewage Disposal System at: ---••» ... .C� .k::.,��_,T 1_l�: fas ---_----..-»e--------- �s^ .�. �`_........�� » .......................................... .._. ».. Location-Address or Lot No. 1 iLL -�. MAP\) VE\F___R\ .................................... c�t�� r�r er�Tca 1T MA. ' _ Owner Address a •-•_ ........................._ AA�.�- ---------------------------------------------. .............................................> .........................All Installer Address d Type of Building Size Lot_4.,17. 7----' _Sq. feet U Dwelling—No. of Bedrooms ____» __________________________________Expansion Attic (140) Garbage Grinder (L))S Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------ •-------------------_--_---------- W Design Plow...........�'_ }_c5n --____gallons per person per day. Total daily flow______. �* l .......................gallons. WSeptic Tank—Liquid capacity__!.�,�__�.__"gallons Length_A '- �`Width__ '-R``_ Diameter.......... Depth___- !,nt`t x Disposal Trench—No_____________________ Width.................... Total Length________._____...___ Total leaching area....................sq. ft. 3 Seepage Pit No._______-________ Diameter___-_.X.O. .-_____ Depth below inlet..... ...... Total leaching area__<_'�•�1_.._.sq. ft. Z Other Distribution box (Y6) Dosing tank ( t aPercolation Test Results Performed by.... *A M .f?e.......... Date___1 _7_�7 0)C)l--------- Test Pit No. 1--- �....minutes per inch Depth of Test Pit_____ ......... Depth to ground water__r��Y__F �uµ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------- L............................................................................................................ 0 Description of Soil----- ---- '`1 n�►_ �ata_y_t,_•__�._..l',• A1 '� x w ------•-•----•-•-•••-••--•--• .............•••••-._..._.---..._.....--- -k----•--••••••••--•-•:•••-••-•--•-•--...-•----•-----•-••-•.............................................................. ••-•-•-----•------------•---••-•---•---•-••--•••-•-••-•••-••---••--•--•--•-••--------............................-..................................................................................... U Nature of Repairs or Alterations—Answer when applieable............................................................................................... ------------------------------------------------•-------------------------------------•----.......---._....------------------------------....-------.................................................. 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 �N.....-................-- --- �' ���'R- -------------------- -- ��=q Application Approved BY ..............................— ---------- ----------------- -Tare Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------- .---------..... f ---.................. ------------- ---------------------- . ............................... � ^Z� 6' ��ePermit No. ....... ..' - --------------------- Issued ------------------ - ---- ... ....-- ---.. Dare THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE (felr#ificttte of Coz plianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---------------��A L-•- 1 Installer� at /- ------------- ----------- '1Q -------- --------------`----------.....---------------------------........----------------------------------------------- -- has-been installed in accordance with the provisions'of TITLE 5 of The'State Environmental Code s4's described in the application for Disposal Works Construction Permit No. ...... -�'- h. ......... dated ........... ./90 ............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I - DATE.....11.. --�----��-�----------------------------------------------------------------- Inspector ....--- /1......................... "—................ V THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ) C, No.-.%.:..z 6 (n FEE.....`.L-�.= 11ispasallam —urku Tonstrnrtiun "permit Permission is hereby granted-------•-.�`caln-n.••.................._.-----------------------------•-----------------..._...-.-•-----._.._...._..._...---------•--- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No........)._`� =� ........... / -• kne4`- �i` -------------------------- a Street / s shown on the application for Disposal Works Construction Permit No._1D-_.Z�,Dated-_____..62 ;/.?v �, / `/ Board of Health DATE..........;-------------•-------------------•---...-•--------•-•---•---.....---- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS r' .. . ... . . _.... .... . -..� ■roc�M n�t•Y• ivGG E ,4/-jiLv i )A641 �o x z� � = �o G.,oa. �� PLCIL-5TL ?71�► _S.c;_ _ SB'S.�.� k /•G -- /$�� G.P.O. i . . : I - .. PFF'fER ; _ ESS733 Y U � f 1 r r LoArvl 47 z ' az V P 46 ' 5eA�l Nlto. W_Z ; s"" . . T GLO lo' F_L=3G • LaC.4 r10 y �o�-v/7"CZ-.2 T/.c'Y T/-rAT T�/- ,�cv�=Gt r,�� ,�10Wit/h/E,eEO.C/COis-Jf�L YS l s//Tf� SC,q Jp /.< /E A�/O SETBA Ck -23 o CA TEv 1,1/iTh�/�t/ Th�E .� G2DPL�4/y, B 4 XT,E,C 6 k /NC. �"!-//s O.L.4.t//s i(/G�T BASED Opt/.4it/ �2EG/STE.�Ep �v SU.eY6}�or�j iVST.2U�l.�i�/T SU,etiEY 7-h4CF- '�"•4SETS SyaLc/.s/S,�UL� M07— 27 .LIST /NHS AG.f'� /C,gic/T" ✓ i i � � I P¢op Q M to rA 4&,o �0 i /sir I i s� f a Rza a� � 4e. nl�lEL_Lihl!� — �wAT y v tf I g Qe'+. I I t'SU•�� R'o 's7- V OF PETER SULLIVAN 7 R U NO. 29733ISTV xF; z: ;2