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Home My WebLink About0100 POPONESSETT ROAD - Health (2) 130 PINEY ROAD COTUIT r- !. A = 020 075 I� r I� �t C6' CONCRETE BOUND FOUND ,p TO14I r OF BARN rABLE OAT e_ O• "J f M . „r . r so .�nycyen.,,rF E' .rw.wans _ O ._ 09% 22.1' �6 24.201 985. 4 ............. EXISTING DRIVEWAY c CD 7.40- Ln LOT '204 - , 15 058± S.F. 8 07 \ #130 / CONCRETE I P Woy y' / NQ R BOUND 39.8' 32•27, / QOSZ P FOUND 18.5' / N6 fo CONCRETE LOT 205 BOUND FOUND A CONCRETE BOUND FOUND k COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION F t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 130 Piney Road Barnstable(Cotuit),MACS Owner's Name: P A Whritenour,TTEE Owner's Address: PO Box 2046 Cotuit,MA 02635-2046 Date of Inspection: September 13,2007At Name of Inspector: Gary J and/or Jane E Rabesa Company Name: Rabesa Subsurface,Inc dba Warren Cesspool Service Mailing Address: PO Box 2302 Teaticket,MA 02536-2302 Telephone Number: 508-540-7143 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 15.340 of Title 5(310 CMR 15.000). The system: 4 " X Passes Conditionally Passes ' ; Needs Further Evaluation by the Local Approving Auth6fity ; Fails i Inspector's Signature Date: September 25,2007 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:The Title V system,installed in 2000,has no previous failure signs. The tank has not been pumped. ****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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: YES X 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. 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 statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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: 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: I Warren Cesspool Service 508-540-7143 T41. c 1„ -+;- G..-Aii ci')nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 130 Pine Road P Y Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 C. Further Evaluation is Required by the Board of Health: NO Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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. 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 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: Warren Cesspool Service 508-540-7143 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for 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 clogged SAS or cesspool —X_ 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 available volume is less than 'h day flow —X_ 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. _X_ 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. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ 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 forma NO (Yes/No)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: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gad to 15,000 gad. 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 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—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. Warren Cesspool Service 508-540-7143 Trio c17nnn 4 Page 5 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 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 out in the previous two weeks? r 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 the 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)]. N Warren Cesspool Service 508-540-7143 r'--A/1 ci,)Ann 5 I Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): three Number of bedrooms(actual): three DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 gpd Number of current residents:two Does residence have a garbage grinder(yes or no):yes(not recommended) Is laundry on a separate sewage system(yes or no): no [if yes separate inspection required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no): no Water meter readings,if available(last 2 years usage(gpd)): 2005 avg.274gpd,2006 avg 156 gpd Sump pump(yes or no): no Last date of occupancy: occupied. COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow(based 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 Source of information: (owner)not pumped since installation. Was system pumped as part of the inspection(yes or no): 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 _no_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 components,date installed(if known)and source of information: 2000 compliance on file. Were sewage odors detected when arriving at the site(yes or no): no Warren Cesspool Service 508-540-7143 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE M INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 BUILDING SEWER: (locate on site plan) Depth below grade: 16" Materials of construction: x cast iron _ 40 PVC other(explain): Distance from private water supply well or suction line:town waterline 22 feet. Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: X(locate on site plan) Depth below grade: 16"(outlet cover raised to 5" below grade) 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) Dimensions: standard 1500 gallon septic tank Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: l" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle:-14" How were dimensions determined: onsite Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank has no failure criteria. The DEP recommends pumping every year with disposals in use. The tank has not been pumped. 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.): Warren Cesspool Service 508-540-7143 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: Seatember 13,2007 TIGHT or HOLDING TANK: NO(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: 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.): DISTRIBUTION BOX: YES(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.): The distribution box is 23" below grade and has no failure signs. 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.): S Warren Cesspool Service 508-540-7143 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Piney Road Barnstable(Cotuit),MA Owner: P A Whritenour,TTEE Date of Inspection: September 13,2007 SOIL ABSORPTION SYSTEM(SAS): YES (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: _ leaching trenches,number,length: x leaching fields,number,dimensions:one: 12' by 35'. 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.): From"as-built"on file,there are five infiltrators in a 12' by 35' field providing a minimum of 330 gpd of leaching. Viewed by remote camera,there are no failure signs. 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): no Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 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.): Warren Cesspool Service 508-540-7143 J Page jO of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 130 Piney Road Barnstable(Cotuit).MA ov ner, P A Whritenour,TTEE a�e of Inspection:September 13,2007 ASK TCH OF SEWAGE DISPOSAL SYSTEM NOT TO SCALE Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or h-�r.cl harks. Locate all wells within 100 feet. Locate where public water supply enters the building. � S�WI✓� t t 1 t. DOD �31 0 CIC, I-P S6PT I C- -TA tjI(-.- �I- 2.)-' 61-- Warren Cesspool Service 508-540-7143 n � S- LaMLT ''� 63 V,,— 411 ctlnnn 10 s -page i I of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) F op__rty Address: 130 Piney Road Barnstable(Cotuit),MA Owner:_ P A Whritenour.TTEE *ate of Inspection:September 13,2007 {,1'dE EXAM Slope surface water Check cellar ;hallow wells FE' tirr.ated depth to ground water is greater than 10 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: 1999 -- - � g Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: previous inspection on file Checked with local excavators,installers-(attach documentation)Engineer's certification x .Accessed USGS database-explain:town topography maps,USGS survey maps You rpust describe how you established the high ground water elevation: From"as-built"on tile,required separation satisified. Elevation over lot is greater than 45'MS(1. bOsest water body is Lewis Pond,with an adjusted elevation no higher than 19'MSL. LE—QS TH1%)3' Tt,Ea 1> j Warren Cesspool Service 508-540-7143 �i+�.a 1' jn nr�nntinn Anrn, tiirci�nnn 11 ' f _ • Town of Barnstable f tHE l°� Regulatory Services BAMSTABLE. Thomas F. Geiler, Director 9� �9 ,0� Public Health Division ArFp�rA Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. easnNG CRAWL SPACE eo�nNG (VERIPO CONC. SLAB (VERIFY LOC ON) (VERIFY LOCATION) CLfOTPJC 7-10° C05TWG FULL B SEMENT Pu' rca M.YnNG �? CONC. SLAB EnSnuc.wocoGKr v — cxs N (VERII°17 ryERiFY LOCATION) (CENTLK OP bUYN HCIEE?) Q W MTR m , ,I 1T-10* 1a-z• IS'O° Is'-a 7 pro 60� s� e � TOWN OF BARNSTABLE UkATION /3 Q 0 i iWj. Ro hzel Cowl- SEWAGE # 9 ?— C� VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 6/t 1-!s 7—A-,.,A FS 9`,1 r iy SEPTIC TANK CAPACITY / "'0 0 LEACHING FACELITY: (type) 1 h E i l`f ra ivr (size) /d X 3S NO.OF BEDROOMS I BUILDER OR OWNER o to v4•t k- PERMITDATE: �'�/2 rA? COMPLIANCE DATE: r`4-42 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 f e o eachi cility) Feet Furnished �'' � ,. �_1 �,� r �� /�� ` No. - a ct Fee r� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ve PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppifcation for Mie;pozal *pztem Construction Permit Application for a Permit to Construct( )Repair( 114grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. gpa_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Ld W+P 20 Ao cti. - A L Q� u� ✓r; Installer's Name,Address,and Tel.No. �- TV 17 Designer's Name,Address and Tel.No. G A rty aA-f2- TA-V-A*6- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank ,�rr9 O Type of S.A.S. S" �i f v� 7KA- � Description of Soil 60 A-Iq 10 `-W d, Nature of Repairs or Alterations(Answer when applicable) �ci lug �r�� k C t 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 iss by Boar Health. / Signed Date 42/z 6aL- Application Approved by n, Date t�_2 5t_ 9 Y Application Disapproved for the following reasons Permit No. Date Issued No. � :. r}n "' ` Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes - PUBLIC HEALTH DIVISION -'TOWN OF BARNSTABLEi MASSACHUSETTS v� ZIppYication for -Migozar *proem Construction Permit ti tT Application for aPermit to Construct( )Repair(j,-'fJpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1110 P+17 1 v Owner's Name,Address and Tel.No. Assessor's Map/Parcel II'�- -e A L p +e 40 I/r,-. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 d gallons per day. Calculated daily flow "3 3 a gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank reel 0 Type of S.A.S. 5r/w F� / 7o-,* a-e S_ Description,of Soil LC7 b P41 it/t cec l a Aw.- S 4-le G� , Nature of Repairs or Alterations(Answer when applicable) Ru U4 D I"r l( r N e IS Date last inspected: 13 4 5 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 Envi onmental Code and not to place the system in operation until a Certifi- Cate of Compliance has been iss - by Boar Health. ! / Signed , - Date/2/ 2 f wt Application Approved by Date _A Fs- Application Disapproved for the following reasons t , r Permit No. Date Issued -----------.------------------ t, J-------- f fl THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS , Certificate of (Compliance THIS IS TO CERTIFY,that n-si elwa2q� ®s System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by �hfil i' at has been constructed in accordance with the provisions of title 5 and4he for Disposal System Construction Permit No. - dated Installer Designer The issuance of this a t}s�al not be construed as a guarantee that the s ""i )f} tin aV esignvfl�Tj"& /� Date K Inspector /1 "} � JJJ No. l 7 — 9/ / Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS xi5po5ar *p5tem Construction Permit Permission is hereby granted to Construct( )Repair(,-�Upgrade( )Abandon( ) System located at I r) 11-11 . DA C� 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: I Z - >.R- f Approved by�� TOWN OF BARNSTABLE LOCATION L3 1 7v I SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE No. SEPTIC TANK CAPACITY -13ec LEACHING FACILITY: (type) S ;,, F'J, I I-rA fie,- (size) NO.OF BEDROOMS - Z — BUILDER OR OWNER PERMIT DATE: 1.�4 b /11,-COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 f o eachi, facility) Feet Furnished rwzdl� ------------ ia 1/6i99 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 PERT IIT (WITHOUT DESIGNED PLANS) I")?L hereby certify that the application for disposal works construction permit signed by me dated i;:�z!o<�� concerning the property located at /3 o Cc l4 z ti (�o 11 -4 t�r�i�`f 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 dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the madmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 1-50 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) B) G.W. Elevation _the ivita'(. High G.W. Adjustment . _ 0 DIFFERENCE BETWEEN A and BO SIGNED : DATE: (Sketch proposed plan of system on backl. q:health folder.cat �? D 73 LnT IVO. . ADDRESS: �3 b r OWNERS: NAriE I 0 SE14ACE PERMIT NO.9'L-6-22, NEW: REPAIR: �� r)DATE ISSUED:-DATE INSTALLED)/4Y'�� INSTALLERS NAME: " INSTALLATION OF: UAT-9P,-T-U-LE : FINAL INSPECTION BY: .DRAWING OF INSTALLATION ON REVERSE SIDE : �' s ;.�' 4 �� ' � � „ � �r_ .. � � ��' �� ,ice•, �, TOWN OF BARNSTABLE LOCATION _SEWAGE # _v VILLAGE �� ASSESSOR'S MAP & LOT OdO-073 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) -NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No THE COMMONWEALTH OF MASSACHUSETTS i BOAR® OF HEALTH f TOWN OF BARNSTABLE Appliration for Bispwi al Works Tnnitrnriion Famit 5 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at* ,� y C;�C-_ ..: . . ...� . ................................... ------••-•--•-•-------•-••-..___-••-.------ -..__.....__----- r cation-Address or Lot No. •••- v .a. _._.. .... o ------•-- s.. �. t �� dress Installer - Address - d Type of Building Size Lot.4.b aDZ......Sq. feet U a DwellinglZ`No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 e of Building a Other—T yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ----------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ (Z4 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ 04 ® of Soil............. -••--- a- Description x U ------•---------------------------------•---------------•---------------------------------------------------------------------------------------------------------------------------------------------- UW --••-------•------------------------------•---•-•-------------------....•---------------••------•-----------. Nature of Rep" r Alterations—Answer when applicable_____ _ __ _____ .......................... . _.. ._.__.......__.._.._____._. . ? - -- ----------------------------------•------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance a been - sued b the b and of health. Signed .....---- -............. � 1 Date Application Approved By .................. sue--•r- e �------ Application Disapproved for the following reasons: ...................... ....------.........---- ---- -------... --....---------------.......------------------------ ...... .. ... .................. ......... .. ....................... .. ........... .......................... ..................... ......................... ............... . ...................................... Permit No. ------ f day...................... Issued ......... Date j+ l No.. .........te a ( �� ' ...... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE 14 Appliration for Eliip.a i al Works Toutitrnrtinn Prrmit Application is hereby made for a Permit to Construct (W-)"—or Repair ( ) an Individual Sewage Disposal System`at: �QQ „ ...f� r_-.. '.:! ...................................................... -•--•--•----.....--••-----•-•---- ---- ------•--......_..---•------------------.. w cation-Address or Lot No. ------------ . n. .}, '•-� W.' dress InstallerAddress !I1 Type of Building Size Lot.a.a aA4).__...Sq. feet V Dwellin 4No. of Bedrooms___...._...�._.................... Expansion Attic a g p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ........•--•-•- ------------------•---•----•---•----.•-------------------•-------•----•----...-•-•----•---•---------------.....------•---•----_----- W Design Flow........ ............................gallons per person per day. Total daily flow..........:=-� _...._....___._.__..._...gallons. WSeptic Tank—Liquld capacity.`.._?._"!.gallons Length_' _.1...•.. Width.__...__.—__. Diameter________________ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. I Seepage Pit No._-____1-_.__-_____- Diameter-----1:............ Depth below inlet..../�>............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___--______-__---__--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a _- -- Description of Soil... . '`^ L- "A. , 1 t o — '2 t r` .. ...t .........................................•-- J.. ------------- •---•- -- -----•--------------- U Nature of Repai r Alterations—Answer when applicable......X�-�•____._..�-�� •�J/ -----------I. -- - ---------------------------------------------------------------------------------------------------------------------------------------------------- Agreement:, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE,5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance a been ' sued b t�ardealth. Slgned . -- — -------- ../ 4' ..........,--/ -------- y ( 1 Date Application Approved By .................. -� V--- s� e Application Disapproved for the following reasons: ............ ................................................... ..........----- . ---..........._-------------------- y Date PermitNo. .........0 J.. ....................... Issued ----.................................................. to Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Trrtifiratr of Tomplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or 1.� p nstaller at ... ---- - we - ------------------------------- --------------- ------------------------------.-...- --------- has been installed in accordan - with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... Q�--- -..E�.............. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ------ --------------- -fit I�� I Inspector --- t � � �. C DATE-- ................i Y wJ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE r^- No.;. -.: .. FEE.. ............ Dispos a Vorkv trnrttinn rrntit Permission is hereby g ranted i ----------------•----------•--•-••-•-•---------•----•.......--••-•---...............-•------- to Construct ( or Repair :an Indio du 1 Sewage Dispos System Street as shown on the application for Disposal Works Construction Permit No;.....*_.. .._...__ Dated.......................................... ................................ s aTa of Health DATE..................;/. l ................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS REVISIONS: NO. DATE DESC. THE STRUCTURE IS LOCATED IN ZONE C. _ AS SHOWN ON FIRM COMMUNITY PANEL 250001 0021 D, EFFECTIVE DATE: JULY 2, 1992 sc/voot _ ST - R E E T I CERTIFY TO THE BEST OF MY PROFESSIONAL KNOWLEDGE, INFORMATION AND BELIEF THAT THE LOT CORNERS, DIMENSIONS AND SETBACKS TO THE RESIDENTIAL ZONE: RF. STRUCTURE AS DETERMINED BY SETBACKS: FRONT 30' INSTRUMENT SURVEY AND AS SHOWN ON SIDE 15' THIS PLAN ARE REAR 15' OF GROUNDWATER OVERLAY DISTRICT: AP �w No.3M DEED BOOK 845, PAGE 375 �� , '' ASSESSORS MAP 20, PARCEL 75 PROFESSIONAL LAND SURVEYOR DATE Z CERTIFIED w PLOT PLAN a AT /V 0 130 PINEY ROAD o 0 0 Z IN a Q a COTUIT W CONCRETE MAS SAC H U S ETTS ,o BOUND (BARNSTABLEE COUNTY) ro FOUND CONCRETE S76. I BOUND - 50 ')()'E 2 ,� FOUND j 32.86' CONCRETE BOUND AUGUST 9, 1999 FOUND ,00 . ST 4! SSoA y I \ 22.1' s9 o I 24.20' 8S• PREPARED FOR: rn � EXISTING DRIVEWAY 1'c\ PHILIP A. WHRITENOUR OD q SF�\ P.O. BOX 2046 c (— bass.- — _ 7.40 �c�f-\ 130 PINEY ROAD coO /'�F\ COTUIT, MA 0 1 I � � S ;10 \ 02635 L � D , � LOT 204 M \m _ Z o�H,��. R 7 15, �58± S.F. 0 8.o I - r p . #130 / r h GE - o �N �� / / RP�L FAN CONCRETE o A BOUND .8' 32.27' / ?w P FOUND The BSC Group, Inc. 18.5'"1 68 � Zn�w / N 657 Route 28, Unit 6 West Yarmouth, Massachusetts 02673 or 508 778 8919 _ C) 1 !sL.IJ �-_.Lt _._ _.._.l - C 1999 The BSC Group, Inc. - - - o _ 1 _ j CONCRETE LOT 20:� � Gas SCALE: 1" = 20' BOUND e4 eO h C't,jed, 0 1.25 2.5 5 NHS 3 FOUND 2 6,4,ram 33� n. D At 0 10 20 40 FEET . � �f �> w 0 OD 6(n 5'_�F ' ? 411foe . Pev )D% PROJ. MGR.: C. FIELD 00 J 0 FIELD: P. H. / A. D. CD CALC./DESIGN: K. HEALY CONCRETE DRAWN: K. HEALY BOUND CHECK: C. FIELD m FOUND FILE: 8092-CPP.DWG DWG. NO: 5158-01 SHEET 1 OF 1 JOB. NO: 4-8092.00 a k