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HomeMy WebLinkAbout0088 LOVELL'S ROAD - Health 88 'LO TLV ROAD a CotUlt S S i 7 i r Mar 03 1412:53p p.18 t Commonwealth of Massachusetts Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is Cotuit required for every MA 02635 2-28-14 page. Cityrrovn 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:When A. General Information filling out forms �µquurnnpr�r� on the computer, OF use tab ` � ,4 key to only your 1. Inspector �sq0�% cursor-do not James D.Sears : = JAMES — —use the return _ k ; Name of Inspector =10 CapewideEnterprises,LLC Company Name 153 Commercial Street 4q �51 iNSP 0����``�� Company Address . Mashpee MA 02649 i City/Town state Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes El Fails ❑ Needs Further Evaluation by the Local Approving Authority 2-28-14 is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions It ons of use. � 3 ! Title 5 offidal In Subsurface Sewsoe Dlspwal rim•page i cf 17 t ' Mar 03 1412:54p p.19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name inform.Won is required for every Cotuit MA 02635 2-28-14 page. ciyfrown State Zip Code Dale of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E I 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: 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 exfiltradon 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): tsft•M 3 Tide 5 O idol hspeaton Fow subsurface sewage Disposal system•Page 2 of 17 s' '► Mar 03 14 12:54p p.20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro owner Owner's Name information is Cotuit MA 02635 2-28-14 requiredquired far every page. cityfro%" State Tip Code Date of inspection B. Certification (cons.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes (cunt.): ❑ 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 311)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 ❑ or Cesspool privy is within 50 feet of a borderin vegetated wetland or a sat marsh P P Y 9 151ns-3/13 wo 5 Offidal Inspecpan Form Subsurface Sewage Disposal System•Page 3 o117 Mar 03 14 12:54p p.21 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Omers Name information is required for every Cotuit MA 02635 2-28-14 page. CitylTown 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 dogged SAS or cesspool ❑ ® Liquid depth in is less than 6"below invert or available volume is less than'!Z day flow i l— t5ins•3rt3 Title$Official In spection Forth:Subsurtaoe Sewage Disposal System•Page 4 of 1T Mar 03 1412:55p p.22 Commonwealth of Massachusetts Title .5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is Cotuit MA 02635 2-28-14 required for every page. CiNfrown 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: ❑ ® 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—I.WPA) 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. Wkw 3M3 Tnk 5 offi'vet Inspection Fam Sdmrface Sewep Disponal sysmm•Paso's of 17 i Mar 031412:56p p.23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Lovells Road Property Address John Baldlasaro Owner Owner's Name information is Cotuit MA 02635 2-28-14 required for every page Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? JD ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out?' ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the ske has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. El ® 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.3l13 Tale 5 offidei►ivaction Form:Subsurface sewage Disposal System•Pape 6 of 17 Mar 03 1412:56p p.24 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldwaro Owner Owner's Name Information is required for every Cotuit MA 02635 2 28-14 page. City/Town State Zip Code Date of Inspedion D. System Information Description: The system is a 1500 Gal. Tank, D Box and two pits. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2012,42,000Gals 2013,42,000 Gal s Detail: Sump pump? ❑ Yes ® No i Last date of occupancy: oPrazesent Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑.Yes ❑ No Water meter readings, if available: !Sins'-3113 TiUe 5 Offidal kapedion Form:Submateoe Sewage Disposal System-Page 7 of 17 Mar 03 1412:57p p.25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is required for every Cotuit MA 02635 2-28-14 page. Cityf town state Zip Code Date of inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 05/08/11 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): i5rrla?3M3 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 8 of 17 it i Mar 031412:57p p.26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Ownees Name information is required for every Cotuit MA 02635 2-28-14 page_ CitylTown State Zip Code Date of Inspection D. System Information (cons.) Approximate age of all components,date installed (if known)and source of information: 1986 Permit # 86-346 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on sife plan): t 38° Depth below grade: feet Material of construction: Q 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.): Pipeing is 4'PVC SCH 40 & SCH 20 Septic Tank(locate on site plan): Depth below grade: 29' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal. Precast Sludge depth: t5ins.3113 Tdo 5 Official Mspecfim f am Subsurrece Sv v p Dispoeef System-Page 9 of 17 Mar 031412:57p p.27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is required for every Cotuit MA 02635 2-28-14 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" Asbuilt-Tape- Plan How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level.Tank and out let cover at 28" below grade. Inlet cover at 2". Inlet tee,outlet baffle. No sign of leakage or over loading. 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 um in : P P g Date tsars-3M 3 TiBe 5 Olfidd kwpection Farm:substafaw Sewage 130osal System-Page 10 of 17 Mar 03 1412:58p p.28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner owner's Name information is required for every Cotuit MA 02635 2-28-14 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.): I Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gapons 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 t5ina i 3113 Two Onldal Impaction Form Subeurlace Sewage Disposal System•Page 11 or 1T } Mar 03 1412:58p p.29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro owner owner's Name information is required for every Cotuit MA 02635 2-28-14 page, cityrrown State Zip Code Date of Inspe lon D. System Information (cunt.) Distribution Box(if 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 leakage into or out of box, etc.): D Box is new 2-28-14. D Box is 16"x16"-32"wlcover at 6". Two line's out. 7 r � I 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.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Ons-3M 3 lWe 5 Orriael trepee ion Form:Suburfecm Sewage Disposal System-Pape 12 of 17 - Mar03 1412:58p p.30 Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is required for every Cotuit MA 02635 2-28-14 page. City/rown State Zip Code Date or inspection D. System Information (cont.) Type: ® leaching pits number. 2 ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number. ❑ innovative/aftemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 1000 Gal. Precast Pits, w/1'stone per plan. Pit#1 at 3'below grade,dry w/stain line at 2'. Pit#2 at 45"below grade w/1'water, stain line at 30" No sign of over loading or solid carry over. No high stain line. 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 3n 3 Title 5 Otrdal(nspedion Fosre Subsurface Sewage Disposal System-Page 13 of 17 Mar 03 1412:59p p.31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro owner owner's Name information is required for every Cotuit MA 02635 2-28-14 page. Citylrown 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.): I 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.): f t5Crte:•W13 Tf9e 5 Offldd Inq)ed lon Form:Subewface Sewage Dlepwal System Page 14 of 17 3 r f Mar03 1412:59p p.32 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forrn-Not for Voluntary Assessments 88 Lovells Road Property Address John Baldasaro Owner Owner's Name information is required for every Cotuit MA 02635 2-28-14 page. Cityrrown 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 ('/JRA A-/ - r'f o*7' B i� �3 =3�,-� 101 2 o fa `y=38 -4, B-y = V9 t5ins'-3n3 Title 6 Oftel hspec6on Fonn:SubwAaoa Sewage Disposal System•Page 15 of 17 Mar 031412:59p p.33 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Address John Balda saro Owner Owner's Name information is required for every Cotuit MA 02635 2-28-14 page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells o 14' Estimated depth high ground water. 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: DDate84 ❑ Observed site (abutting propeitylobservation 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: T.H.on design plan 4.6-84, no G.W. at 14'. Bottom of pit at 9'below grade. Bottom of pit at 5'above T.H. depth. Before filing this Inspection.Report, please see Report Completeness Checklist on next page. LSins 3113 Ti9e 5 Widd ftispeWm Form:Subsufsce Sewage Disposal System•Pepe 16 of 17 Mar 03 14 01:00p p.34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 88 Lovells Road Property Add Tess John Baldasaro Owner Owner's Name information is required for every COtuit MA 02635 2-28-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B. C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t6ins-3113 ride 5 Olfichg Inspection Form:Subxnrace Sewepe Disposal System•Pape 17 of 17 No. v i Fee (� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for 30ispoSal 6pstem Construction Permit Application for a Permit to Construct( ) Repair()Q Upgrade( ) Abandon( ) ❑Complete System U Individual Components Location Address or Lot No. !99 (,D vsu,,5 kb dove 1 r Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ©a,5 ®5-I g2,7 LOv L&S Rb o . u t Installer's Name,Address,and Tel.No.50 8.1471 —g%11 Designer's Name,Address,and Tel.No. ,0,4Qt;Wtt); w 2tsa: Uc. NIA Type of Building: L1Dwelling No.of BedroomsK6__ Lot Size � I sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 14 Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Certificate of Compliance has been issued by this Board of He>4. II Signed �11 Date aI —01--7"��i`4 Application Approved by Date N Application Disapproved by Date for the following reasons Permit No. Olo 11 56 Date Issued No. �_O -I " Fee 160 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Misposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair(P Upgrade( ) Abandon( ) ❑Complete System [Individual Components Location Address or Lot No. �� (,p�j�r,�s �j� �p�`�. Owner's"Name,Address,and Tel.No. Assessor'sMap/Parcel Qa O 8$ (.Over .t)Q cl i T7o - ti y Installer's Name,Address,and Tel.No. 50 g,(JI I -g g 11 Designer's Name,Address,and Tel.No. � C Type of Building: Dwelling No.of Bedrooms Lot Size 1,L "sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 1 gpd Plan Date Number of sheets Revision Date Y Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) ) 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 Certificate of Compliance has been issued by this Board of Hea h. Signed Date Application Approved by tj Date e�' Application Disapproved by Date for the following reasons Permit No. P-O I Lf J C 6 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by C,40C4_)1 n& �NT r2tS UZ at ?g (,,O U ELLC, Q(aO�C) has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.' �� dated _ f Installer E S LJ,L Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed /as a guarantee that the system will nc-£ion as,desig`ned. Date / 112- Inspector --------------- ------------ - ------ _- - No. dd1L o Fee / 60 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(4 Upgrade( ) Abandon( ) System located at R S j a l fr_ a is RnA N ao_rC)I_T� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. t� Provided:Construction must be completed within three years of the date of this permit. Date '�' t' Approved by lu• . No� to & w t' FEE.......................... _ THE COMMONWEALTH OF MASSACHUSETT$ BOARD OF HEALTH , ..................OP....IJo.C'v�.......u�,Vp ,..-.....4-`'.......-.--.....-....._. Appliratiun for Disposal Works Tonotrnrtiun Permit Applicatiod is hereby,made for a Permit to Construct ( ) or Repair (y ),ari- Individual Sewage Disposal ` System at .... w l� ............. aa .�_ -;�--_ _______________ -�:'.r_.� ^I._._�-: P . o....... _.- Location-Address or Lot No. ................_....__•___.............................................:......................... .................................................................................................. �, Owner Address a ......•.....� ... `ale ^•-•^ --............................ .... ._ Instal ler .� Address Type of Building Size Lot ....233 Sq. feet V Dwelling—No. of Bedrooms_________________________________ _____Expansion'Attic ( ) - - Garbage Grinder ( ) ►-� Other—Type of Building __.. No. of persons____________________________ Showers Cafeteria G4 pt xtures ......:.:.:.. ... d ............. Desi Flow... .. ........ allons er person g Total da'11' low.............. _. 660 to W gn ............ g P Pe dzy. }� ..- .._ WSeptic Tank—Liquid capacity)oo�?._gallons Length__. _.- Width:_!_Z. Diameter_________________ Depth.�e x Disposal Trench—No. ................:... Width..................... Total Length..................... Total leaching area....................sq. ft. 3 . Seepage Pit No..................... Diameter....................... Depth below inlet..................... Total leaching area..................sq. ft. z Other Distribution box (K)` Dosin to ( ) # Percolation Test Results' Performed b .. �?`_��!L_ �'�'' Date....-A..- . 8. ............. Y �• •• •--•....---;;... a Test Pit No. 1................minutes per inch Depth of`Test Pit...,; _:_._. Depth to ground water...ha' Test Pit No. 2................minutes,per inch Depth of Test Pit.................... Depth to ground water_.._-2v.co�v� �i i�_....:...:.................................. _.......t�...............rr.. ., O Q QG�Vv� SU`OcSo1I..... \8 _ Coav��.....; vale, ... Gtt Description of Soil...........'. ...,.: . ... t•-•----•-•--•--••-•••..... ..... + -- wee �J o. . 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 JITLZ 5 of & State Sanitary Code— The undersigned further agrees not•to place'the system in operation until a Certificate of Compliance has een issu the board h h. . gne - -- --- _E.. .............. .... -•-._ .... ........ . `!�d+ -••-Date Application Approved By...:.......... _... 3. �2`. .••-••/ Date Application Disapproved for the following reasons:................................................................................................................ ........................................ .._.. __....-•----....M._.__.._......................................• .................. ._._..... . .__........... Date Permit No......... Issued....................................... .. .... • - ��� � Date•k �..•"'`=--•—� —v� � `� �' FE$............._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD,,.OF HEALTH Appl ration for Diiipasal Vorkg C owitrurtion Permit Application is hereby made for a Permit to Construct 0Q or Repair ( ) an Individual Sewage Disposal System at: ,�-.... ..._... • -•....... ..--- ............t-.�„ P• Location-Address or Lot No. ......................_.......................................................................... .............---.....---.....----.............---•--.......-------•----........................... Owner Address a .................I .. ............................... .... .................... ... Installer Address 'Type of Building Size'Lo .. �3...-:...Sq. feet .-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T ,ype of Building............................. No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other, fixtures -----------------------•------.._...---------------......................-------------------•••-........._.._......riCo ................. go Design Flow-----.--���-..........................gallons per person dpLy. Total 1,y�ow.....-'�' - .,--•--•...........galleons, Septic Tank—Liquid capacity 19n�?..gallons Length................ Width:--•...__-_..... Diameter................ Depth. .. ... x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet....................Total leaching area..................sq. ft. z Other Distribution box Dosing to ( ) a :�'Percolation Test Results Performed by.. ................. .:.. ..._ _:__ " ...---...................... Date...i.-�...8�:.....:..:.. Test Pit No. 1................minutes per inch Depth of Test Pit...!!��...... Depth to ground water..-hco �e� fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth,to ground,water........................ PG .....................................%............. ................. •.... .-••-...... .. 0 1 tI c�o�Vv� svlv5o,1...- 1�.. V i ... �d........................ Description of Soil........ = A.............. ........-.I------. Se F � cn }d U .........-•...........................•-•-•--•--.........---•---•---•--•---........------......--------•--•-------------•-•:r------------•------...------•-------••------....,-.........�.........-•---- W ------------- ------•------------------------------------------•--•-----•-----•--•............................................................................................... V 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:ITI E 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 €h h. ; Si n ... ........ Application Approved By._........_. Y1 "'. X' -� / '�� .................... .... Date. .......... Application Disapproved for the.following reasons: ............................... --•-•-------...._......-----...-------------••--•---•................. ...................................................:............:........................................................................................................................................ Permit No...... .� ..� N ...... Issued.•------•...........................................Dau....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o f>� OFF lf6L ................................................................. (Inrtifiratr of Tomplitturr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b -�-f2r�{�- ------•....._.............................................. y.................. ..................... ......•••. .......... Installer at......._..._l-.` `........_ 1. c� 1 ......----•----•------- has been installed in accordance with the provisions of TI'� F 5 of The tate Sanitary Code,a descr'bed in the . 2 L 22 . application for Disposal Works Construction Permit No....��_._..:--�.�.._..____ dated..............��....._.__���......_... . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE 4 SYSTEM' WILL FUNCTION SATISFACTORY. f' S �� ) A DATE................ �. 1 ......------.............................. Inspector................................................................................. ........... s mil.-•.vrt id. ,te..->.-...�.. - .,.r"................w r w a e s 0 E+n d 6.i n..r..a x,y,ram.e a is+.x...n�r r sr.a.n r a w m n x.................. THE COMMONWEALTH OF MASSACHUSETTS w " BOARD OF HEALTH ........../..�h/N OF............""'...... No.. ....`....... ...................... :......� Fn... .. Disposal Works Tonutrurtion Perm t Permissionis hereby granted., �C--•---------------------------------------------•_---------.............-----•-------•---........................ to Construct ( ) or Repair�( ) an .Individual Sewage Disposal System / at No................I—L, ----•-••i�E3.-------•--.....•....!t ..`... �---�--E...J..-r ..r_....-. .... Street 9 �}�/// �G 3 `/2 as shown on the application for-Disposal Works Construction Permit No------------ ----- Dated...___. ..._..._. - —--- ,may Board of Health g, DATE............ ' J.. ...... .:6 . ASSESSOR'S MAP NO. Oe2-:�' PARCEL LOCATION ,,-w g, SEWAGE PERMIT No. Vl'rrVG E Ce,7 CI I 7— I N S T A LLER'S NAME i ADDRESS t)OI UILDER� OR OWNER =_ DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �: ,. �A�q L- E �s f q 'f �� � U �� � t8 �� �� � l� 3� j 0 SECTION ' SEWAGE Id -SEPTIC TANK- S':,. _"D:.BOX - 31 _LEACH hi TOP.OF FDN /P / (MSU.N O I , WASHED STONE I 3r* ✓f v �t 1-IZ 1 ey 1 V Gr' 10T ' IN• ti � N OUT- OUT- I N. • .N. l f•b.� `w 162.0 ICI.S701 SEPTIC IGI:S{j` ;' o ;"i<oG \ E�° t.64.5 ''... TANK IC-0.7o i o r:. ELEV. ELEV, ELEV. . _ 1 ELEV. 0 • - - - - (R =a, 161. 16Ot�3 i � I ELEV. ELEV. a• r; / 5: • j, tt. r , OF iW•'` , WASHEp bT0 I f Y 1 1 r . 4 � _ TEST'HO E LOG P 33 0 - bott«�Io*4e�t hdc ete�r 15c�:5c� CAA ,N ' FFo�n(�a � f col �,, AT , TEST _ ' . WITNESS } I i L 6 TEST DATE '1T1 L-1 C� DESIGN - BED ROOM EDROOM HOUSE ` zi5 /`xh:__ T.N: e 1 I T.H. +� 2 , gip/ ELEV.''// ELEV. NO a DISPOSER QISPOSER 4 �i63.Q)I$ JIa PERORATE 2 MINA FLOW RATE'jIOx (GAL.LDAY) 5 Q SEPTICTANKA4CQ... (2.)= _ �6 I63 -� ` . as '< InIM►ii. � - 4 _ : REQ'D SEPTIC TANK SIZE 10 LEACH FACILITY - - IQ'12 2.5 3'TG;g; -- / I SIDE WALL., � �. G/D. (�� .,`�. r VP. 5b,50 BOTTOM . TrC �?= :ea (1 0 ) . 50`24 G/D. '''� �� 4_ I'; - TOTAL 201.1 K 2 4Q2g(' A27.04 05+00 GAP 4 1. USE: � LEACHING 61 EFF t?rrro k ��o - o'+^`N --. ► < 1 WATER ENCOUNTERED - , t �•---------j- \ ,tea,1� I S�j Co2 NOTES:':(UNLESS OTHERWISE NOTED) x 3-►--- _ �� I g ^-:_,a.. .. _ �ss, i` 1.DATUM(MSU* TAKEN FROM Co-T QUADRANGLE MAP - -_ 2.MUNICIPALWATER I AVAILABLE 8:PIPE PITCH:W"PER FOOT - 4.DESIGN LOADING FOR ALL PRECAST UNITS:AASNO- -44 yG yam . Or e� OF 6� -- N� Sr MIN:GROUNDCOVEROVER'ALLSEWAGEFACILITIES-(1)FT. ARNEH f'' 6:PIPE JOINTS SHAL--L BE MADE WATERTIGHT 0��� %- 7.'CONSTRUCTION DETAILS'TO 9E•ACCORDANCE WITH COMM.OF MASS. CIVIL: L. 157 STATE ENVIRONMENTAL CODE TITLE S ov �oSITE PLAN 8: -tuna ac.a,,.J F=c.G 7Y��^ a ►-so+ciC c�.►1�� a..ab b+ao���-p REG.PROF L ENGINEER - ti REF: _YGp 39 GG0 y.H OF down :cafe, en�►ineering' �� �y Jos,l ��►.a�.5d A PREPARED FOR: CIVIL ENGINE ER; BOARD OF HEALTH . .. EGAB SU OR. 4C�1 LANOSURVEYOR (EXISTING)............. `' SI/1 Stjw• _ � -' n - SCALE 65 - CONTOURS (PROPOSED)-0-0-0�- - APPROVED - DATE ^� �'�' �A = � c