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Home My WebLink About0015 HIGHLAND AVENUE - Health 15 HY (:HLAND AVENUE, COTUIT A= � - ® ,� ------ --- i r . 1/ TOWN OF BARNSTABLE LOCATION SEWAGE # _ld S VILLAGE �� !'�% 1 ASSESSOR'S MAP & LO&Z� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY � c LEACHING FACILITY: (type) ��- (size) NO. OF BEDROOMS BUILDER OR OWNER Ra,��,w PERMITDATE: _�COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Faciliti Feet Private Water Supply Well and Leaching Facility (If any /exiiston site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands ex within 300 feet of leaching facility) Feet Furnished by t , b NX, TOWN OF BARNSTABLE LOCATION �.� />'`9 fV �� 1a y SEWAGE # � l VILLAGE 1 G��i ASSESSOR'S MAP & LOT ' INSTALLER'S NAME&PHONE NO. ��i A Sd R.' Sp SEPTIC TANK CAPACITY ��'�`S + LEACHING FACII.TTY: (type) 'L (size) NO.OF BEDROOMS .� BUILDER OR OWNER PERMIT DATE: !' COMPLIANCE DATE: 6" �" ✓ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Le/exist Feet Private Water Supply Well and Leaching Facility (If any onsite or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands ex within 300 feet of leaching facility) Feet Furnished by _ a , a c l 1 TOWN OF BARNSTABLE LOCATION/S_IV, / rid e&e, SEWAGE # .VILLAGE (�d1�U. ASSESSOR'S MAP fez LOT OVO INSTALLER'S NAME & PHONE NO._? SEPTIC TANK CAPACITY LEACHING FACILITY:(typc) %jf�!(f (size)_�� . NO. OF BEDROOMS - PRIVATE WELL OR PUBLIC WATERAU�e BUILDER OR OWNER DATE FERMIT ISSUED:. _ -- — DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i ; F 3 D aa � �q3 No. — Ya-01— r Fee $50 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for ]Dtopaar *pztem Construction Permit Application for a Permit to Construct( )Repair(x)Upgrade( )Abandon( ) ❑Complete System El Individual Components LytioT 1drress fraLn oAve . , O%yner's vame,Address and Tel.No. 1177 HH tt111 cis Cotuit MA William and Janet Robbins Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P0 Box 1089, Centerville , NIA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) new Title-5 septic system consisting of a IHank. D-box and. 2 leach chambers, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bard of HeO. Signed 1 Date W Application Approved by Date :Z—.1 G — Application Disapproved for the ollowtng reasons Permit No. ! — �5_� Date Issued oar - ay3 No. - 'T 4 ...r.i Fee J 0 THE COMMONWEALTH OF MASSACHUSETTS `-Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF B-ARNSTABLE, MASSACHUSETTS 01pprication for Dizpboat *pgtem Construction Vermit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System El Individual Components Lpc i°fiig iyandN°Ave. , C otuit, MA W011V lam'and Janet Robbins Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville, NIA Type of Building: `Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other _ Type of Building No. of Persons Showers( ) Cafeteria( ) �;.Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand .fir.. Nature of Repairs or Alterations(Answer when applicable) new Title-5 septic system consisting of a bank, D-box and leach chambers. Date last inspected: Agreement: r The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systefn in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by t 's and of He . Signed 1 Date Application Approved by Date 7—,1 G —92 Application Disapproved for theYollovYing reasons Permit No.-_ — y 3r Date Issued THE COMMONWEALTH OF MASSACHUSETTS Robbins BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY, that Ihg On-site Swage Pispsal System Constructed( )Repaired( X )Upgraded( ) Abandoned( Eby Wm. E. Robbinson ep lc ervice at 15 Highland. Ave, Cotuit, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. f �f,i`2 dated Installer Wm. E. Robinson Sr. Designer ,J The issuance of this�e t s all,not be construed as a guarantee that the s s ill unct'on signe. G + , ,0 1 Date Inspector fI ! i' I 0 11 y No.��•� --------------------------Fee $50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Robbins Oitpo,5a[ *potem Con.5truction Ver nit Permission is hereby r ted to CQnstru�t( )Repair(X )Liprade( )Abandon( ) System located at KHlghlan . Ave. , Cotul , MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: -7 — d —�9 Approved by S k e 1/6/99 NOTICE: This Form Is To Be Used For the'Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, William E . Robinson,S,rhereby certify that the application for disposal works construction permit signed by me dated 2"o? 9 �' _ , concerning the property located at 15 Highland. Ave . , Cotuit, MA meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the welling. ` • The soil is classified a CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no well ds within 100 feet of the proposed septic system • There are no pri ate wells within 150 feet of the proposed septic system • There is no i ease in flow and/or change.in use proposed • There are o variances requested or needed. • The bo om of the proposed leaching facility will not be located less than five feet above the maxi 11111 adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor me when applicable] If the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) �• o B) G.W.Elevation +the MAX.High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B L' SIGNED : d DATE: [Sketch proposed plan of system on back]. q:health folder:cert f- f Y'7-a e 1 1 j� I _ r - + f TOWN OF BARNSTABLE . U LOCATION /5- p�, /qh� Ct'�e . �'� 8+� SEWAGE # VILLAGE C`p��,� ASSESSOR'S MAP & LOTOab �L-cZ.Gc,G INSTALLER'S NAME & PHONE NO. 9411'1,1IMAI _ hvuSe SEPTIC TANK CAPACITY / 4 Ve-' r TEACHING FACILITY:(type) % �,� _(size)_ �4Z' NO. OF BEDROOMS _3 PRIVATE WELL OR PUBLIC WATER u'c BUILDER OR OWNER DATE PERIMIT !.SSUED: — �1 DATE COMPLIANCE ISSUED: � VARIANCE GRANTED: Yes No .!' SUBSURFACE !SEWAGE DISPOSAL SYSTEM INSPECTION PO Address of property /5- J} %,9 RfC EO Owner ' s name n,�:V: oc avfiL Daie of Inspection 6 SAY 1196 i s {. P"T A �{ r6Fe4rarr J CHECKLIST P&!nPcrr�� ; f` Chick if the following .have been done: I Pumping information was requested of the owner, occupant, and Board of Health . None of the sys,t"em components have been pumped for at least -two creaks and the system has been receiving norral flc« crates during that period . Large volumes of. water. nave not been introduced Into the / system recent l.ylor as part of this inspection.. As built plans have„been obtained and examined . Note if they are not available with NIA:, .: ' !ice The facility or dwelling was inspected for signs of sewage back-up, ._... ' The site was inspected for signs of breakout . All system conpon;nts ; . e'xcluding the SAS , have been located on the site . V The septic tank- manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, �. material of construction, dimensions, depth of liquid, depth of sludge , depth of scum. The size and' 3.ocation of the SAS - on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants , if different from owner) were i. provide8r ;ith information on the proper maintenance of SSDS. Al. • I I i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;Y PART B ' SYSTEM INFORMATION J FLOW CONDITIONS If residential number of bedrooms -�7 number of current residents NO garbage grinder, yes or no ---ems laundry connected to syster;, yes or no IW(_)� seasonal use, yes or no { , If nonresidential , Calculated flow: Water metier readings, if available : � ��1`� 3.TOU0 I � � Sr � ul��O � d � I.l 1i /CS Last date of occupancy 'k GENERAL INFORMATION :!Pumping records and sourc�e/.' of information: fIr y System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping : .(Type of system ii Septic tank/distribution box/soil absorption system Single cesspool "j Overflow cesspool i Privy Shared system (yes or no) ( if yes, attach previous inspection E records, if any) other (explain,) Approximate age of all componenCs , Gate installed, if known. Source of information: i 1 C) {.P e/A r-1. Sewage odors detected when arriving at the site, yes or no i • i a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION eontinUOd SEPTIC TANK: --ob (lobate on site plan) depth below grade :__--... material of construction: _—concrete ----Metal ___Epp __other(expl8in) dimensions: sludge depth i distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scuT. to tOP Of outlet tee or baffle distance from boll-tom of scum, to bottom of outlet tee or. baffle Comments : (re6ommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to autlet i.nvert, structural. integrity, evidence of leakage, recommendations for repairs , etc, ) DISTRIBUTION BOX !AZ-6 (locate on site plan) depth of liquid level above outlet invert Comments : (note if level and distributicn is equal , evidence of solids carryover, evidence of leakage into or out of box , recommendation for repairs, etc. ) PUMP CHAMBEP: (locate on site plan) pumps in working oirder , yes or no Comments :(note condition of purp chamber, condition of pumps and app4rtenancea, recommendations for maintenance or, repairs , etc- ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) ' (locate on site plan, if possible,- excavation not req�iired, but may be approximated by non-intrusive methods) If not determined to be present" , explain: Type leaching pits and number leaching chambers and nur-ber, leaching galleries and number leaching trenches , number , lenath leaching fields , number', dimensions overflow cesspool , number Comments : (note condition of soil , signs of hydrailic failure, level of pondihg, condition of vegetation, recommendations -for naintenanc,$. or repairs,otc. ) CESSPOOLS (locate on site plan) . I number and ccnfigurat,ion -V 9 ouchU.; depth-top of liquid to :inlet r invert :depth of solids layer depth of scum layer. 7 1 dimensions of cesspool materials of construction 'indication of groundwater inflow (cesspool must, be pumped as part of inspection) ; Comments : (note condition of soil , signs of hydraulic failure, level. of ponding, ; condition of vegetation, recommendations for. maintenance or repairs,etc.) � PRIVY : ! (locate on site plan) ,materials of construction :'dimensions ;depth of solids Comments : ; (note 1 (note condition of soil. , signs of hydraulic failure, , level of ponding, :condition of vegetation , recorcmendations for maintenance or repairejetc. ) "'n SUBSURFACE SEWAGE D H ISPOSA YSTEM INSPECTION FORM PART SYSTEM T.NroRKATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: I anent*. references landmarks or benchmarks include ties to at least two Pe.r--m 16cate all wells within 1001 is Ur DiPTH To GROUNDWATER depth to groundwater x method of determination or ap. 0mat,jon. -------------- Name of Inspector ` Company Name E a Company Address 6a'7 Certf,jcatkon Statement I certify that I have personally inspected the sewage disposal. system at this address and that the information reported is true, accurate and complete as of the time of., inspection. The inspection was performed and any recommendations recardi.ng ut:trade , maintenance and repair are consistent with my trainirg and experience in the proper function and manitenance of on-sit? sewage disposal systems . Check one ; T 1� I have not found anv information which indicates that the system fails to adequately protee t pub;. ic health or the environment as def.incd in 310 CMR 15. 303 , Any failure criteria not evaluated are as _ stated in the FAILURE CRITERIA sect ion of this form. I have determiner that the system fails to protect publ,i.c he,%Ith and the environment, as definer in 310 117M 1.` . 303 . The basis for this deter,{ inat.ion is provided in the rAILE).RE CRITERIA section of this form. i . Inspector ' s Signaturec 'r,� � c2�� - date (UA; 61 Original to system owner R terra +'( z_, Y''c. C Lj Copies to; 'Buyer ( if applicable) `Approving autbority i I