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Home My WebLink About1000 MAIN STREET (COTUIT) - Health 100---Main Street (CQtuit) Cotuit >P A e 034 061 L-OC-QTI-O-t�l=� .- SE-W-Q�E-P-ERMI-T-1�l-O: VIL--CAGE - - - - - - - 11�1 S-T-ALL E-R-5-W-- E- A D-D-R E-S S �z�r►K ��57'�►2 ��n�� /�� rd ��K �p• YD 5-W-L D E-R-5-1J-/-IAA-F S A D-D R-F S S 1-7 D-A �C M P�.1 Q:t`►-C-E . a. ., f. . „ _ '��€` ... --� � .. /� C/ 12�t.,._ 14.gc__ (J� � .. NO.•-•Aw ------ Faa.. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F -HEA TH Appliratinn for Diiipofiat Workii Tonstrurtton Vrrnift Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at• - -------- .... .-•-- ---. .---------•--....-• --------------------------•--.......----- Locat- n-Address / or Lot No. .._.. ._.--__- - _- ..... - __- __.•- _. •8 ----- --------- ----- --------------------- -•_•-------------••----_-----•------------ --------- wner Address WD •• ... ---- . -- ----- t - Install r Address Type of Building Size Lot.............---------------Sq. feet U Dwelling 4-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons_--_-.----.--_-_-----_--- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------- - W Design Flow ------------------- `�--W. Ions per person per day. Total daily flow -'�--- . ---gallons. P4 Septic Tank Liquid capacrtyons Length________________ Width................ Diameter_-.-....__---__ Depth.._---._-_.--... Disposal Trench—No....... .... Wid h.-• otal pL h ;! otal leaching- Disposal -----------sq. ft. Seepage Pit No•-----f------------- Diameter./ tall e Total leaching area sq. ft. z Other Distribution box ( ) Dosing,tf�nk ( ) '-' Percolation Test Results Performed by.-.--it_4441-_' �`'--0'0�-7____._ Date___ �_ W Test 'Pit No. 1----------------minutes per inch Depth of Test Pit--------7 Depth to ground wall __._-____:_--.--_--...- Gz Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ --•--------•--- ei —- f:............. i. Description of Soil.___.._� o. if DescriR ._... __. ._.__._ x U -- --• - •-2- � a-® = - W ----------------------------' s' - --- Z �� - i-------- - - ------------........................... 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b:een issued by the,bbQard of healt . Signe ....•. •-•-- 'o . . -•--•-•--• 4. ---•------------------ D Application Approved BY. Date Application Disapproved for the following reasons:.......................................................................................................=........ -----------------------------------------------------------------•--------------------------------------------•---••------•----- ,; -•---•-------------•-•--••.......•-••••......-•----------------•-- Date PermitNo......................................................... Issued...................... ................................. Date --- -------- -- - --_�_ -� �_ _ -- _---- -_ - -_ -=��e_= �-------------------- ---- No._-- I Fps.. ................ No__Ay THE COMMONWEALTH OF MASSACHUSETTS SOAR® F I-BEA TH ;. - --------- Aplifirntion -for Disposal Works Tonotrurfion Prrmi# Application is hereby made for a Permit to Construct ( Aor Repair ( ) an Individual--'Sewage Disposal System at ! Locati Address or Lot No. _ _____ -__ ..... ... A _________________________________________________________________________________________________ acaner s � Address•-•-•• 1 Install Address Type of Buildi Sq. feet U YP g Size Lot �-, Dwelling •No. of Bedrooms--------- - """_________________________Expansion Attic ( ) Garbage Grinder ( ) Other'—Type of Building ______ ___________________ No. of persons----------------------------- Showers ( ) — Cafeteria ( ) 0.4 Other" fixtures ___-____--_____ dt ----------------------------------------------------•----------- . -_. -• ----------------- W Design Flow_ ___________ ions per person per day: Total daily flow._._._. _..+ Q""V_ ._gallons. WSepric "1_tink�Liquid capacity ______ allons Length________________ Width-____---_..-._. lli meter_:._-- Depth_-_-_____ -_---. x Disposal Trench=No.____.___,.____,_____ Wid II__"" otal L Me _ _ ________ otal leaching area_-__-____:______sq. ft. S ' - b 1 Seepage Pit No------r--------:___ Diameter_ _ _______ el ._.___________ Total leaching trea___.__--_-.______.st ft. Z Other Distribution box-•(,. ) Dosing nk Percolation Test Results Performed by:.___ ¢__* Date___ 7, a Test Pit No. 1................minutes per inch "Depth of Test Pit-------- __________ Depth to ground w er---________-____---__... G� Test Pit No. 2....._%........minutes per inch Depth of Test Pit____________________ Depth to ground water-------------------------- ... �/Description of�Soi1 p �i"',• lI „` V- '-- -- -- ---- ---yam' -{� 1. x - - / Q------- :.. - W -•-----•--------------------- �- : --== r - x Nature of Repairs or Alterations—Answer when a licable._ `'- U P PP ti --- ----------------------------------------------------------------------- -- _: - -- - --., .. Agreement The undersigned agrees to.,.install the aforedescribed Individual..`sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersig`' ed-further agrees not to place the system ill .` operation until a Certificate of Compliance has been sued by the bo rd of-healt ,�. t Signe ----------•----••- D e Application Approved By.. ... to (� 1.40 . r Date Application Disapproved for the following reasons:- --- ----------------------------------------------••-•••--•----••-•••--•-•-• -------•--•---_•••- Date PermitNo......................................................... Issued......".. ----- -------- ---- ......7 4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .: O F...... t46 - (9rdifira#r of fITOmpliaurr T 1 TO RTI hat the Individual Sewage-Disposal System constructed ( or Repaired ( - ) b ...... d----- ' / �__. Installe � ''\at_ --•- ----•-••••-•- _ -- -•�----•-- --- - ---'r • l has been installed in accordance wit the provisions of Art. e .XI of The State Sanita de asa-AT-T-H-E d in the a lication for Dis osal Works Construction Permit No.__ __ __.______ dated--. �6PP P •+3`THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED .4 AR " SYSTEM WILL FUNCTI SA ISFACTORY DATE--- ;4, ---••-•-=i•� Inspector-- -------------------------- ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT i No.)_ �_,,,,�__-•. ..... .i0`F. , '`. +' ,' +�1 _ l" .-... FEE .. _ / ,.., i-s o or nstru Pion Vrrmit Permissionis hereby granted____ ...__________ j 1 ----------------------------------to Co at N ristruc or Repair ( an i � age Di/��l"1 System 4 �-- ---: -`- - --- ------------------ : y________.. _ Stree as shown on the application for Disposal Works Construction P •t Noy_ Dated._ .______ ,�� Xrl LO ------------------------------------------------ FORMoar ea ..----...� DATE___ t �'r 1255 HOBBS & WARRgg! VIVC.. PUBLISHERS ,Yr3"+=�r1f 1,I,sY a , I BARNSTABLE SURVEY CONSULTANTS, INC. MUMBERSHIP IN: MASS. SOCIETY OF PROFESSIONAL ENGINEERS SURVEYORS AND ENGINEERS s LAND SURVEYORS POST OFFICE BOX 734 4 1 1 M A I N S TREET CAPE COD SOCIETY WEST YARMOUTH. MASS, 02673 PROFESSIONAL ENGINEERS TELEPHONE: 776-7719 & LAND SURVEYORS '0/ 7 . August 22, 1973 Dr. Mary Jane Luke Box 5605 Roland Park Station Baltimore, Maryland 21210 Re: Lot off Main Street Cotuit, Mass. Dear Dr. Luke: On August 17, 19731 we inspected a test hole on the above referenced lot, the results were .as follows: 011 - 611 Loam & Subsoil 6t1 4211 Clean Medium Sand 4211 12011 Clean Fine Sand No water encountered These results indicate excellent percolation. If we can be of further assistance, please do not hesitate to contact -us. - Very truly yours, William G. Weller WGW/nm LAND COI,IRT, i • r'• PRPPKR Y, • ` RIGNT ),QF WAY y , SOUNDfNGS • FILL PERMITS .3'� �" 1 m * r ' �w�'p/►� R LANDFIL `iL�Cik`Y i39 qqyy 6,�,fC CCO• x 9#Ya aW,c Z Ti: YK '^ +. tY '`t�,y } g..3 s t 5� p .,. Y 7-yg L TK ACT } 6 '. ,3" .." tfi�.< t'. r YI" _.. f �rrgt+'` i #r _ +g 3 �+ -lee 94 rye >�s All a�t e� umw;gyx'uuwv(.xwMaMMaeA»M •.w,.rrr+ �9 (r 4 • i Y' 4 �; �s. t� 2 •k1 T �q .ems/ . • ,`.�`'i � - L ; ��•t • 1� P f SPA� �t 4 COMMONWEALTH OF MASSA CHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENT ' EIVED .. : JUN 1 5 2004 TOWN OF BAR.NSTABLE . HEALTH DEPT.. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1000 Main Street Cotuit Owner's Name: pp 'Hic-kman ARC EL Owner's Address: LOT Date of Inspection: Name of Inspector.(please print) W i 1 1 i am E_ •Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P 0 Box 1089 Centerville, MA Telephone Number: t5081 775-8776 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.lam a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).' The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: tl,. - �,—o L 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 seat 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 I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 1000 Main Street Cotuit Owner. Peter Hickman Date of Inspections av Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. S rem 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 rep ired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please exp in. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally uns und,ekhibits substantial infiltration or exfilrration or tank failure is imminent.System will pass inspection if the exi ting tank is replaced with a complying septic tank as approved by the Board of Health. • metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance icating that the tank is less than 20 years old is available. D explain: Observation of sewage backup or.break out or high static water level in the distribution box due tabroken or obstructed pipes)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 qD explain: The system required pumping more than 4 times a year due to broken or obsmlcted pipe(s).The system will ass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rtmond explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_ 1000 Main Street Cotuit Owner: — Date of Inspection: . 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 fai ' g 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 2. ;ystem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst m 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 Goff 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 coliform bacteria and volatile organic compounds indicates that the well is Gee 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: 1000 Main Street Cotuit Owner: Peter Hickman Date of Inspection: 6 D. System Failure Criteria applicable to all systems: Yo must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow 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 I00,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. L Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private w-atrr 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.] (Yes/No)The system fails.l have determined that one or more o(.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: arge Systems: To a considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 g Y u must indicate either"yes"or"no"to each of the following: to following criteria apply to large systems in addition to the criteria above) yes no ilte system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well if yo 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 faded.The owner ar operator of arty large system considered a sign ficant 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 S of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1000- Main Street Cotuit Owner: Peter Hickman Date of Inspection: 4'_e/,a 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? V _ Has the system received normal flows in the previous two week period? 1/ Have large volumes of water been introduced to the system recently or as part of this inspection Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? v 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? _ _V`l 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 Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance. is unacceptable)[310 CMR 15.302(30)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:1000 Main Street Cotuit Owner: Peter Hickman Date of Inspection: - V - 0 1. FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design):. Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): G d Number of current residents: Does residence have a garbag gander(yes or no)://G Is laundry on a separate sewage system(yes or no):,!G� [if yes separate inspection required] Laundry system inspected(yes or no)*!2: Seasonal use:(yes or no):A,,U Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 3 - 95, 0 0 0 Sump pump(yes or no):,4!�d 2002 - 1.1 8,0 0 0 Last date of occupancy: --9/o. COMMERCIAL/I USTRIAL Type of establishme t: Design flow(based n 310 CMR 15.203): gpd Basis of design flo (seats/persons/sgft,etc.): Grease trap present(yes or no):— Industrial waste h ding tank present(yes or no):— Non-sanitary wa a discharged to the Title 5 system(yes or no):_ Water meter rea ings,if available: Last date of occ pancy/use: OTHER(desc be): GENERAL INFORMATION Pumping Records Source of information: w Was system pumped as part of the inspection(yes or no):,4 C0 If yes,volume pumped:gallons--How was quantity pumped determined? Reason for pumping: TYPOF SYSTEM L.-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) _Tight tank '—Attach a copy of the DEP approval _Other(describe): Approximate age of all conwonents ate installed(if know )and source of information: l Were sewage odors detected when arriving at the site(yes or no): 6 I'agc 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1000 Main. Street Cotuit Owner: Peter Hickman Date of Inspection: — G BUILDING SE'YE (locate on site plan) Depth below grade: Materials of cons tion:_cast iron _40 PVC_other(explain): Distance from pri to water supply well or suction line: Comments(on c ndition ofjobmts,venting,evidence of leakage,etc.): SEPTIC TANK:_✓(locate on site plan) , t Depth below grade: l Zj_ Material of construction:_✓concrete metal fiberglass_Polyethylene _other(explain) — — If tank is metal list age:_ Is age confrtned•by a Certificate of Compliance(yes or no):_(attach a copy of certificate) m Dimensions: L x S Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:__ Q_J Distance from top of scum to top of outlet tee or baffle:__f J- Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ,DLL .da GREASE TRAP:_(locate on side plan) ) Depth below grade:— Material of construction:_con etc metal fiberglass_polyethylene_other (explain): — Dimensions: Scum thickness: Distance from top of scum to to of outlet tee or baffle: Distance from bottom of scum o bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping reco unendations,inlet and outlet ice or baffle condition,structural integrity,liquid levels as related to outlet invert,ev' cncc of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOI1M PART C SYSTEM INFORMATION(continued) ProperiyAddress• 1000 Main Street o ui Owner: Peter Hickman Date of inspection: TIGHT or HOLDING T K: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: oncrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity. Rallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm'i working order(yes or no): Date of last pumping: Comments(condition of-alal and float switches,etc.): DISTRIBUTION BOX: t (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUI11P CHAMBER: (local) on site plan) Pumps in working order(yes or o). Alarms in working order(yes or o): Comments(note condition of p p chamber,condition of pumps and appurtenances,etc.): 8 I Page 9 of l l • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1000 Main Street Cotuit Owner: Peter Hickman Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation'not required) If SAS not located explain why: Type 7 eaching pits,number: I t 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.): - / p G e' �,�L S l6 i�li ��-�✓6 L-- � y�3 i�a l� t-0 � o�i1 CESSPOOLS: (cesspool must b 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 r no Comments(note condition of soil,sie 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,sign of hydraulic failure,level of ponding,condition of vegetation,etc.): t. 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1000 Main Street Cot»i t Owner: PPt-t=r Hickman Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. � 1 Y 10 f Page l l of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1000 Main Street Cotuit Owner. Peter Hickman Date.of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water I feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-if checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: flecked with local excavators,installers-(attach documentation) ✓Accessed USGS database-explain: You must describe how you established the high ground water elevation: I ll LOCATION 5EWo,6;E PERMIT M( - - �.a e9 IWSTt�U ER A 5 WwE DDRESS ) - GUILDER 5 Q &MF- ADDRESS DATE PERMIT ISSUE[ D A.TE COMPLI &,aCE ISSUED . l 1 r TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ADDRESS: l000 m n/Al krT' �F 7- � 13 X 519 MAP NO. 03 PARCEL, NO. 0(9 OWNER NAME: r;9'rpr, k NLA foil /4!C K A4 A A/ � V fLL'AGE: T U! INSTALLATION DATE: 9'C-PT. BY: ADDRESS: CERT. NO. TANK INFORMATION ' LOCATION OF, TANK: D;;� OOS UA)APP b til 'wW— IPA ALL 6-Af3 J11 CAPACITY1000 GAL.TYPE S TE t- AGE '.� FUEL%BCHEMI'CAL CA jA/6- Q tt-CA TESTING CERTIFICATION E ] PASS E I FAIL DATE LEAK DETECTION Ey1 CHECK IF N/A ,TYPE/BRAND : ,r ZONE OF CONTRIBUTION E I YES E ] NO ,DATE TO -BE REMOVED 4: 2�� FIRE DEPT. PERMIT ISSUED E 7 YES E ] NO DATE LUNSERVATION E ] CHECK IF N/A DATE BOARD OF- HEALTH TAG NO. A , ]E ]E ]E ] DATE xx PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD MAIN S -r R S7 F- -r , C o T U I T 1000 b,elvswAY 000 GAL . TA-#Jk (DIP- s -ricle PIPE PROJSCTS ABOVE G�2ADE) ITAVk I S 1 Z'-0." LOAJG DIAM. ' } r Ytie4` �Zi'aiw .e�r� / rlar 24426 Al Wv AW1111AW wG�21��y u, We Ma+� .r4++ti , 44Aoo tw++�yp�y� tH+Nww+ I� 1 � 7W . } pb{�Gv, IA7W, AM P Z 6 3 s S P E C I F I CA T ION S House in Cotuit, IL.ssmchusetts for MISS OLIVIA FRAME AND DR. MARY JANE LUKE Mhy c o SePT. 071t John Bernard & Son, Inc. -: '. Qat.erville and Archftoeta , April 30 1974, r y - I I 1 , .. ! GtJ�P sfll c�'F r ebc- 5)lt%n 7-r� f 'ra a cova*T a8aemblY. PrDvirlt,: wrM trim, ir:4",41,4 cj,�j VIL --iink,-., 1p-tw-A rind CAP?, ar"I V-T'jv'a 1021jro v-- �'I. 1 , C'-q t:C' t V i t h- d'amp c r c With cn=nuy ezitk'Vera. C,C 3. Pau CoAl I Bezatc-a Ifg y)l torril-3 K-8. 200 DU'! L it"ZO cta -with 3-uzy f an sidl tich. d • -a v,-, a,n a r,d or C a, L'e C.Gr1r, 1, W;rir,,, tO Eairnicr, circulatnor C> ce Cutting aridj patchinne will dona CO to the Dxmstic vzater t'z lIt—m-b-114 Gontrac-tor. -1 Trl TI ) 2-L inttalled in r-rpz=-r x I)--*,n'r Lu-bllj��- tu i,-. CM liiathary or kLweller qu- Q har C t in-g!s Coppar coldcr type. b. Soldvrz 50-50 Tin-Load, Dutch Day. C. Steel Waoi copper Aping after ins La I IL-,,t i P t Pitch pipiarz kwck tauare-I boiler for drainz. i'11 pp"� E.i A&ztf? mdl tion- c:nei- bcl ler connections sba 1-1 Qo agc-=fErrrx to I A All piping sh,-Jl be Supported by standard, accepted I I f in -required to fripport pipe free of sags and un-due ' L V, I shim-11 be kept clear of the frwae- on the h7ailding to elimltulte- Causcd by ex 4 yansion rub. Temporary sup-part of piping ern,,i cr cleate I not be accepted in tho final by th,-!-, The Gontractor shall furnish and install sraol:e pip-ce of '--aniz.cd ircm. The pipes shall bE fulll vizi;." of t;hG &=-d shall te f ir-,dl SUPPorted in poaiticn. The pirms L---haij ft!Ivc-'� ti-j-,'- jointV.. T hey shal pitch upward toward tha cIaLmaney &nd sIL5all ncut ject into the chimney MOLD ad the innar curf.ace of the fju-�c;LnIl L-e fitted with DRAFT CONTRO". DCLU:- Otir- vi ter hea-"ctr hwase heater shall share the sate flue, locate thinblec atleaGt in-" OITri (1) 200O . Sallon Maea. Spec. Undo--groral-al trunk cow.. icote, WI` ve exud -nt with SCULLY vent alarmn, Fl:-4 F*'r..TLr-.LC, H -'-�zr -X POWITAIC Valve. Run copper linos in u!3e-1 FIX NOTE: Iank' mct be located &tic- act lo'-10'" Must a Et east 2'-0" of er-Irth covo-60 0i L ma(h SV� � S M EA® KEEPING YOU ORGANIZED No.q®S34 2453L WME IN USA GET ORGANIZED AT SMEAD.COM