HomeMy WebLinkAbout0051 EATON COURT - Health 51 EATON COURT, COTUIT '
'
A=055-013 �
� 1
l
DATE 6/13/06
PROPERTY ADDRESS 51 Eaton court
cotuit
MA 02635 _
On the above date, the septic system at the address above was
Inspected.
This system consists of the following:
I., 1-1000 ga22on zept.ic tank.,
2.1 1-dizta igut.ion Box.i
3., 2-1000 ga.g.2on leaching pits:,
Based on inspection, I certify the following conditions:
4o 7h.is .i.s a 7-itie 7.ive .6ept.ic zystem (78fiode)
5.1 Septic Zystem .ih .in p2opea woak.ing oade.n at the paesent time.,
SIGNATURE
z -
Name: Robert A. Paolini
rya e
Company: Joseph P. Macomber & Son Inc
Address: P. O. Box 66
Centerville. Mass 02632 C-
Phone: 508-775.3338 or 508-775-6412
JOSEPH P. MACO:BJER & SON, INC.
Tan ks-Cesspoeachfields
Pumped stalled
MRONN
Town Sewennections
P.O. Box 66 Cent , MA 02632-0066775-33385.6412
•
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
a
s.
TITLE 5
OFFICIAL INSPECTION FORM—.NOT:FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 51 Eaton Court
o ui
Owner's Name: Vir iriia Deal
Owner's Address: Same
Date of Inspection: 6 13 0 6
Nance of Inspector:(please print) Robert :A P o.i ni
Company Name: ,. ?. ar-omlo-It on -nc..
Mailing Address:
en e/i DTF.Te, R.q-s13.-02632
---� Telephone:Number: 5 0 8-7 7 5:3 3 3 8
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.1040 of Title 5(310 CMR 15A00). The system:
XXX Passes -
-Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fail
.Inspector's Signature: Date: O(,
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
""This•report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not.address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 1 I
OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Inspection: 6/13/0.6
Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section:D
A. System Passes:
NO I have not found any information which iriftates`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.
om eots:
aeptic zyhtem .ins .in paopea woak.ing oadeaa t the /aaezen.t time.,
B. System Conditionally Passes:
NO 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 sWements.If"not determined"please
explain.
NO 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:
NO-
. 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:
NO The system required pumping"more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)'are replaced
obstruction is removed
ND explain.:
2
.Page 3 df I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner:. Virginia Deal
Date of Inspection: 6/1 :3/6 6
C. Further Evaluation is Required by the Board of Health:
NO Conditions exist which.require fiu-ther 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:
n o Cesspool or privy is within 50 feet of a surface water
n oo 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:
no The system has a septic tank and.soil absorption system(SAS).and the SAS is within 100 feetofa
surface water supply or tributary to a.surface water supply.
n o The system has a.septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
no The system has a septic tank and.SAS and:the SAS is within 50 feet of a private water supply well.
n o The system has a septic tank and SAS and the SAS is less than 100 feet but 50jeet or more front a
private water supply.well".Method used to determine distance v.izuia
i
*"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other
failure criteria are.triggered.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR,VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 51 Eaton Court
Cotuit MA 0263-5
Owner: yirgini a Deal
Date of Inspection F/1 3 0 6
D. System Failure Criteria applicable to all systems:.
You must indicate"yes"or"no"to each of the following1or 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
X clogged SAS or cesspool
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:availablvvolume is less than'h.day flow
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.
_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ X Any portion of a cesspool or privy is within a Zone 1 of a:public well..
_ _T Any portion of a cesspool or privy is within 50 feet of a private water supply well. �..
7 Any portion of a cesspool or privy is less than 100 feet but greater than 50.feet from a private water
supply well with no acceptable water quality analysis.[This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from.that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less,than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached.to this form.]
NO
(Yes/No)The system fails.I have determined that one or more:bf 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 1..0,000 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
the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in Section D above the large system has failed.The owner or operator of any large,system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
4
Page 5 6f 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 51 Eaton .Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Inspection: 6/1 3/0 6
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 outin 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>he 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)]
t
5
Page 6 pf 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Inspection: 6/1 3/0 6
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CM R 15.203(for example: 110 gpd x#of bedrooms):4 4 0
Number of current residents:unkn o wn -
Does residence have a garbage grinder(yes or no)-yeas
Is laundry on a separate sewage.system(yes or no): no [if yes separate inspection required]
Laundry system inspected(yes or no): n o
Seasonal use:(yes or no):_LID 2004._70, 000 ga r?Bona Gl)t7-191., 78
Water meter readings,if available(last 2 years usage(gpd)):'2'0 0 5=10 0, 0 0 0 ga e e o n s G?D_27.,4 0
Sump Pump.(yes or no): no ,.
Last date of occupancy:
COMMERCIAL/IN-DUSTRIAL
Type of.establish-ment: NIA
Design flow(baked on 310 CMR 15.203): gpd
Basis of design-flow(seats/persons/sqft,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 NSA -
Source of information:
Was system pumped as part of the inspection(yes or 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
ob_tained 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:
17 ye-a2.s
Were sewage odors detected when arriving at the site(yes or not
6
.Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Inspection: 6/1 -f 0 6
BUILDING SEWER(locate on site plan)
Depth below grade: 300
Materials of construction:_cast iron _40 PVCX other(explain):
Distance from private water supply well or suction line: 2 0 t
Comments(on condition of joints,venting,evidence of leakage,etc.):
ao.intz a/2Reaa tight No leakage., Vented thaough hou.6e vent
SEPTIC TANK:y,e Alocate on site Aan)10 0 0 ga"o n s
Depth below grade: 2 4
n
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) 8' 6"X5' 8"X4' 90"
Dimensions:
Sludge depth:_. as ce .
Distance.from top of sludge to bottom of outlet tee or baffle. t a a c e
Scum thickness: t a a c e
Distance from top of scum to top of outlet tee or baffle: t a a c e
Distance from bottom of scum to bottom of outlet tee or baffle: t a a c e
How were dimensions determined: m e a u z a e d
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.): _
I ump tank eveay 2 yeaaz Zn.eet 9 out.Oet tees aae .in ..lace
tank iz auc uaa y Zo.und .�
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.):
Gaeaze taap iz not paez.ent
7
I
Page 8 of l l
.OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Inspection: 6/13 0 6
TIGHT or HOLDING TANK: NO tank must be um ed at time of ins ection locate on site plan)
( P P P )( P. )
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.):
7ighi M hoiding -tank-6. ate not. /22ezen;6
DISTRIBUTION BOX: y e 4if present must 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
1 akage ipto 0 out of box,etc.):
l ox Z13 ieveio 11a s Z ea4eaa46.i No zo eid caaayovea oa tekage in
o2 out 0 ox.,
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.):
Puma cham4e-IL .i.6 not aae.sent
8
r
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virciinia .Deal
Date of Inspection: 6/1 3/0 6
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
Rocs¢ edcazee ppag y10.�
T pe
leaching pits,number: 2
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/altemative system Type/name of technology:
failure,level of ponding,dam soil condition of vegetation,
'signs of hydraulic fail , g
Comments(note condition of soil,sig y P g P
etc.):
Loamy to medium ;,P.ine zand., So.i ez aae day., Vegetation .i s noama e.i
o 12on tag goth 12.t z weae d.,zy at Time oZ .insRect.ion.,
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):.
Co ents(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Cems,312oozz aae not 12ae-zent
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.):
I)a.ivy .i-s not 1211e-6ent
9
Page 0;of I 1
OFFICIAL INSPECTION FORK—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM'INFORMATI.ON(continued)
Property Address: 51 Eaton Court
Cotuit MA 02635
Owner: Virginia Deal
Date of Tnspection: 6.11 3.1 Of; .
.SKETCH OF SEWAGE DISPOSAL SYSTEM
Provjde a sketch of the sewage disposal system including ties to at least two permanent Wereyce landmarks or
benchmarks..Locate all wells within"100 feet.Locate.where public water.supply enters the building.
,I
-T..........
i ley
GS1 !
66 '
10
Page 11 of 11 ,
OFFICIAL INSPIECTION TORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: •51 Eaton Court
Cotuit MA 0 6635
Owner: Virginia Deal.
Date of Inspection: 6 1 3 0 6
SITE EXAM .
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
'NO Obtained from system design plans on record-If checked,date of design plan reviewed:
y e�s Observed site(abutting.property/observation hole within 150 feet of SAS)
Checked with local-Board.of Health-explain:as A i.i.Pt caari -
no Checked:with local excavators,installers-(attach documentation)
e�Accessed USGS database=explainA t�R:t o wn.,g a a n s t a g i e,r,ma..-u s
You must describe how you established the high ground water elevation:
llsed. : Cape Cod Comm.is.ion rJatea 7ag-ee Codtou2.s And l uttic Uatea Su12P y
G1e n aaea.s mad , Sept 1995
Val-ea icesou2ee6 o ePice cane cod comm.cb.aon
Top
Leaching
Pit eet
Groundwaterti eet Below Bottom-of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore,the vertical.separation distance between the bottoM
of the leaching pit and the adjusted groundwater table is ` '
feet: .I
TOWN OF RNSTABLE 130ARD QF 11$A1,T11
,00SURFACR tit;HAQR D181'USAL RYSTgM IflBUCTIQN FORM — PART D CERTIFICA�'dON.
-TYPE on PRINT CLEARLY-
PROPERTY INSPFCTls11
STREET A04ES$ 51 , Eaton Court Cotuit 02635. ,
A•SSESsORS MAP, DLWK AND 'PARCE'L
OWNER's NAME
Virgipja Deal
PART` D — 0SRTIFI0ATX0N
NAME 'OF 'INSPECTOR Robert A Paoliri
COMPANY NAME �7oset�ri_ Ma r S �'
f. - x6oi]IeMAC2<C32-006JB i-
COhPANY AUD1gSS �
Stsa h TOW or City. Sta t LIP
COMPANY TELEPHONE ( 508. ) fi7.5 3338 YAX (' S08',V f 578
C9RT•ITFICATION. STATEMENT
Icertify that I 'have persotiai,ly .ins•peoted .the sewage digpoea�,. system at
I
his address and that W4* information reported ,is true,. avcUra•te•, aid
omplete as of the tiros .af'�i:nspeetion,►• The inspeotion was perto:rmed and any
recommendations regarding .upgrade, .ma•intenance 1, abd repe.1r ,are• eon$istent
with my trainiRig and experience in th$ proper fuhcti,'on' acid maintenance of on-
site sewage disposal systems,
Check one;
Systeo PAS D ,
The inspection which J. have .•conducted has ,,n•ot• found any information .
which indieateg that. the system' fails to ' adequately. protect .public =
health or the envi.ropment as defined in• .310 CMR. 16 30.3•, Any faiiu•re
criteria not evaluated are as stated in the FAILURE' CRIURIA ;section Of
this, form.
System FAILED*
I The inspection whic), I have o�ndttted -had •found that •the gystem fails to
protect the public Health and the envlronmen•t ' in a000'rdanee with Title
61 310 CMR 15 . 303 j and as -specifically noted an •PA'RT' C FAILURE
CRITERIA of this ins pection .form. '
Inspector Signature Date*
ne' copy of this oertl f ioat•iar MU* t -6e �rovi'ded 'to the .pWN K, the BUYER'
where appli.oablo) and Chip 33QARD 08' 11EA Tl1� •• ; '
I M / Y
* if the inspeetion FAIL'Eb., the .cwne�'.ox "operator •a'ha1,3, . upg•s�►de'•the system•
within o'ne year of the aa't•e of the inspection, unless, allowed ar requi;red -
tharw4se. as urovided iTi 0510 CMti 16 306 .
UIV
To
�1
CAJ
Ar
2��I
f D _
TOWN OF BARNSTABLE d
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS vi
NAME Edwin M. Deal
ADDRESS 51 Eaton Court VILLAGE Cotuit 02635
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAL
1. 51 Eaton Court, front of 1000 gal. Fuel Oil ,6 -r -o.;= Steel
residence, 18 feet from west
corner �� 72—' -7
(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: .. 1. 8/6/7 g 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS
04/02/2004 13:44 5088889093 ENVIROSAF PAGE 02/03
Make.application to local Fire Department. _
Fire Department retains original application and issues duplicate as permit.
• (Q�'I?�Yj24�I2�(l�G�zifif'L ���� C?l ���
,APPLICATION and PERMIT Fee:
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made•tiy; ,
•
Tank Owner Name(please print)
Virginia Deal x
Address
5-1 Eaton Court Cotuit; MA 02635
Srrocr CAy
Slate ZIP
` -
En'viro—Safe Corporation
Company Name Co.or Individual
Print PMI
Address 14$ Tan Sebastian Dr Sandwic gddress
Pnnl
r'rau
Signa re(if applying for permit) Signature(f applying for permit)
Gr1 IFCI`Certified Other r1 IFCI"Certified n LSP# Other
51 Eaton Court Cotuit, MA
Tank Location
Sl�ernadrnw C1y
Tank Capacity(gallons) 1 ,0004 r/2 6b-/30b Substance Last Stored #2 0 i 1
t
Tank Dimensions(diameter x length)_
Remarks:
t
Firm transporting waste Enviro-Safe Corp. State Uo.9 329
Hazardous.wastemanifestf# MAM775677 E.P,A.# MAD985269323
Approved tank disposal yard Turner Inc. Tank yard n 002
Type of inert gas Tank yard addiess 235 Commercial Street Lynn, MA
c
City oor Town �� FDID# D/f^�"� permit#
Date of Issue Date of expiration
safe a rovsl number. 20034204
Dig pp big Safe Toll Free Tel.Number-800-322-484rt
Signature/Title of Officer granting permit
After removal(a)("Consumptive Use"fuel oil tanks exempted)send F rm FP•290R signed by Local Fire Dept.to UST Regulatory
Compliance Unit,Department of Fire Services,P.O.Box 1025,State Road,Stow,MA 01775.
'International Fire Code Institute
FP-292(revised 4/97)
CCBT
Personal Financial Services
April 2, 2004
Barnstable Town Clerk
Barnstable Town Hall
367 Main Street
Hyannis, MA 02601
Att: Lucia Fulco
Re: Edwin and Virginia Deal
Parcel#055013
Dear Ms. Fulco:
Per your conversation this morning with Mr. William Coale, enclosed is the Application
and Permit for the oil tank removal on the referenced property.
If you have any questions, please feel free to call on me. I may be reached at 508-957-
6755.
Sincerely,
Lome L. Garcia, CFPTM
Senior Trust Officer
LLG/bhs
Enc.
10400745
CCBT Financial Companies P.O.Box 1180 TEL: 800.673.2300
South Yarmouth.KA 02664 FAX:S08.394.3691
is%%wccbt.com
5-7
LO C T ION W G PE MIT N0.
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VILLAGE
INSTA LLEWS NAPE i ADDRESS
t_
OR OWNER
DATE PERMIT 4SSUED
DAT E COMPLIANCE ISSUED �-
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No............ ........L e ' _ Fss.............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA T
............... OF....... . ......
.._......_.............
Appliration for Dispngal Works Towitrn.rtion Vantit
Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal
System at:
..? ..s .[ ........CjaleW.2 .. .................AA?.............. .........................................
Location-Address or Lot No.
.��_.�� _..... .....�ZA . �...._....Jasve --------------------------•------.._._........_
Owner Address
W ....c u_Zl__t. 1r1
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms__________________�.....................Expans ion Attic ( ) Garbage Grinder (X)
Other—Type of BuildingCvw rAM? ff*AWo. of persons............Z______________ Showers (f) — Cafeteria ( )
QOther fixture .�'�_� � $/91C1�.�[__ /�e� �.t�• �' te��_�.�fttT. .� u2t��r.. 'i �,---•-•-----.-.-•..
W
Design Flow_______________ .................gallons per person per day. Total daily flow............3,3_0....................gallons.
WSeptic Tank—Liquid capacityl-a_Q__gallons Length____/Ca...... Width_. 1.____.__._ Diameter________________ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
3 Seepage Pit No........iL.......... Diameter___....C.-�._..._ Depth below i let_____ ..�...... T tal 1 Ching area._./&Q..�o_sq. ft.
Z Other Distribution box (X Dosing nk ( ) �c �
aPercolation Test Results t,�A)JPerformed by...`�(�ka�... .. . . . .. ............_.____._______._..... Date__, -�s�__ _.��..�_...
Test Pit No. 1 _____o�._...minutes per inch Depth of Test P- ------A.__._..__. Depth to ground wa r_._N__9.._!✓Ar.--e
Test Pit No. 2................minutes per inch Depth of Test it......1A........ Depth to ground water_.A..,.tl.....wAr_f',�
Ra' •-------•---------------------------------------------------------------------•----______------••----•--------•-----• __-•------------------
... ...
O Description of Soil------g'�..�t-ohm..........2Q�.. S;�iL.............�-�-'-_•._!_!?_ , C1�<+1--•--.r.4w�-........................
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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 TI:':. 5°of the State Sanitary 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.
�" . Signe .R:_�__sS�A_��R.<<.---f.Iss'a'c...�tzR...FA_l,�_/_!✓..._�fJ.�_ ._G�_G�.7_.�_----
Date
Application Approved By........ ,�_� �
Date
Application Disapproved for the following reasons______________________________________________________________________________________________________________•--
---•------•-------------------•---------------...-------••------------•--•-•.._......__..:_
Date
Permit No.......................................................... Issued_./.O:�/"'Z 7Y
Date
�J
y y
No................_..-•-- � � Fps.
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA TH
Y. ...OF........... ..................
App ir4 ivu for Uhipaii al Works Tonstrur#inn rami#
Application is�`hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
....rC r__w.r..AIZI... ................. -� ..............0..;.� ........-----------------------------------
. Location-Address or Lot No.
— ............................................... ..... G?[s .......... r....................
/ Owner Address
W
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling No. of Bedrooms.................3__.__________.___.__._Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Buildin rZP(.,`t.9A.9. No, of persons a Other—Type gC � - � p �_______________ Showers (�' ) — Cafeteria ( )
d Oth.:r fixtu 4.rF ...., .1,0_ � " �1ae?.s �A�.....k/re-!�`' U �y--:Sd��A..................
W Design Flow.........sn,,-:L 7............... .gallons per person per day. Total daily flow........... .....gallons.
WSeptic Tank—Liquid capacityl.f.o o..gallons Length....4t)...... Width---S:.......... Diameter................ Depth................
x Disposal Trench!-No..................... Width.................... Total Length........_..j___.... Total leaching area. ..................sq. ft.
Seepage Pit N ...... ....___.._ Diameter:..... ........... Dep4D , t___. _........... Total Ching area. �'S�° a'sq. ft.
ZOther Dist bution box (X Dosing nk � �Percolatio�ni Test Results Performed by..`` ........ Date.•-••----••.-•----
t Pit No __._.r�h.____.minutes per inch Depth _.f �..______ Depth to ground w er__e __. AL--e
44 est" 'it No. 2................minutes per inch Depth ._.)A.`...__.. Depth to ground water--&-�....t*eA?`�'�
�J �' ------------------------------- ------•---••- -------•------.-----------.---•----.---------•----•-•----...............W 111 _ .........................•--•-.
O d)escri ti n of Soil----.. �� d- �nb----------,.1.0.".. SA!a- ~6 ''
V ...•----- -•-----•--•-•-•=------•.........................•---------......................----------•-•--...... � --..............................................................
W
UNatud of Repairs or Alterations—Answer when applicable...............................................................................................
----•------------•••••--••-•-------•----_--..-•---- ----•-•---------------------------------------------------------------- ...................................
Agreelfnent:
The undersigned agrees to install the aforedescribed Individual. Sewage Disposal System in accordance with
tie provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sign ,....5E���R+�.._���c�...t�?i?..F�?s�?!�..._�!!�t.. ��.?..��_...
ate
Application Approved BY ---- to /Date
' .0.....
Application Disapproved for the following reasons: ................................................................ s; ---------••--•--•-•-------••••--••-
A
f ...........................................
Date
Permit No......................................................... Issued-------if `-6 7.7 ...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH '
............! ......OF..... ..........................'..................... :r.
h �rrtifirFa#r of Tjamph anrr
THIS.IS R , That the Individual Sewage D'tposal System constructed (I'') or Repaired ( )
by-A"t.. _ ....... ---------- •-_..... .............•- ........... .... --••--
has been installed in accordance with the provisions of r f The ate Sanitary ode; as described in the
application for Disposal Works Construction Permit N ..___ _.___._ -_-_--.---- dated_ 1-f.............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE'THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. � E
DATE...... � Inspector_....
11�----77
/ THE COMMONWEALTH OF MASSACHUSETT
BOARD O HEALTH
P17—
............. . .....OF...........� .
-v? FEE.:'. .......:.:.......
. tea jar t ra #ruan rmt
Permission is hereby granted... t -- .........................• ........................................ ....
to Constr t or Rep ' ( ) n Individual Sewage)Disposal System i
at No.
t �� '{ 1 £d.
r f Street
as shown on the application for Disposal Works Construction44:1�
. _._ Dated... "..7
� ••-
...joard of Health I
DATE--- '
FORM 1255 HOBBS'& WARREN, INC.. PUBLISHERS
TOP OF FOUNDATION
CONCRETE COVER
CONCRETE COVERS
0 4 CAST IRONr � 7� `
''• PIPE (OR I2 MAX 4liO�ANGE$URG(OREQUIV.1 12 MAX.
D EQUIVA— MIN. PIPE= MIN. LEACH
° PITCH I/4'PER.FT .-PITCH 1/4"PER.FT PIT PRECAST
° J LEACHING
D' INVERT a
$Q. \—INVERT INVERT ?o Q PIT OR
D , SEPTIC TANK DIST. EQUIV.
EL..24./3• , EL,Z3. 7.5.. ' : ?x
o INVERT BOX • F. Q
GAL. INVERT INVERT �'w w '`� 3/4°TO 11/2Z
EL.�3f$e O:
ono EL.23,S0 ;� LL WASHED
o
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0 /0 I J IO r r.i
—r7l �—
._.. /2�--�—6'DIA.
/O ' DIA---► NO
POF1 LE. OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL 'LOG WITNESSED BY :
DATE / 4y /B /979 .1.�,'r /.eau/ .Murra.t,/
""��.,, . BOARD OF HEALTK
TEST HOLE I TE;§f HOLE 2 TE,KeNC.y� � 0' 0.Mr ?I?. ENGINEER
ELEV. . 2.9. .E. . . . ELEV. .. .. $
C.a/��. GopS. . 'Q��frctiOn �xcc�vu�lo/�
'WOOd loom
D ESG N DATA
S�ihsDi l
30. NUMBER OF BEDROOMS T.n/'e4. . . . . . .
-36 --Tj lAL._ 'Ff MATED FLOW Jam.30. . . . . GALLONS/DAY
Q 'T0* LEACHING ARg�i 78 .50 . . 81Q,FT../PIT
U1 _
`E E IEEA12"ING AEA . IB.S . S.O. SQ.FT./ PIT
SEAL-- Xf5 (5O% AREA INCREASE)
D t _ (2670-1/33.50
,TOTAi-, -F"J 14& RREA SQ.FT
VEIfCOLJTt0N +RATE 4 MO/7 i . MIN/INCH
LEAC Wtl i *sEA 0W PEPOOLATION RATE .55Z5 SQ.FT.IA/T 1
NO.WATER ENCOUNTERED 0� /LEACH)Nfi PITS .TAID. 1�/I•S. . �/T/Y
�► 7'W r'eZ r Q
APPROVED
DATE . . . . . . . ,
AG FBI T OR
OFM,{ss
moo`' TH N F
70¢�. �f�roo.� 'rHOMAS E.KELLEY CO.
No.24260
UNGINEERS—SURVEYORS �9��FGISTo��
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