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Home My WebLink About0663 POPONESSETT ROAD - Health 663 Poponessett Road, Cotuit —A= 006-022 COMMONVVEALTH OF MASSACHUSETTS EXECunvE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARn%F-NT OF ENVIRONMENTAL PROTECTTON sE 5 OFFICIAL INSPECTION FORD NOT FOR VOLUNTARY ASSESSMENTS SUSSU]tFAC.E SEWAGE DISPOSAL SYSTEM FARM PART A CERTIFICATION Property Address:_ 6 ti 3 Anpnn�. -gai- Rd Cnt-n;t MA 029*15 OwmeesNanee:_Paul a Knight= Owner's Address:_Same Date oflmspectio c--fit 11 1-4 Q S NameoPIaqwta;(Pka4ep _Robert, A ant 'ni Via. CompaayNaBr:_J.P-MaCombpr & Sort Inc. MaffhgAddress: Rnx e6, F e'enterville MA 0 2632 Telephone Number.5 0 8—7 7 5—3 3 3 3 "`'r E CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address:and that the informatioln reported.: below is true,accurate and complete as of the time of the inspection.The imVection was performed based on m. �•; training and experience in the proper Function and maintenance of on site se ne dis sal y approvedsystem for � po, systems.I amt DEP spec pursuant to Section / `of itle 5(310 CMR ip5 M). The system: _e +✓ Passes (� $Q� ,t Conditionally Passes XX Needs Further Evaluation by the Localgproving/4uthotity F I i Inspectors S*uatwe: / V � The system inspector shall submit a copy of this inspection report to the Approving Authority(Huard of Heakh or DES within3(}clays al completing this inspection If the system is a shared system or has a design flow of 10.ft gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DF.I?The original should be sent to the sy, i owner and copies sent to tine buyer,if applicable,anti the approving authority. Notes and Comments GalLgage rizpoza$ L3 n2e,3en.t, U•i.th ort.Oy 1-1000 gaUon �e�.t.tc ta,ek.� .. report only desks coaditkm at the time of hmpeWm and under the conditions of use at that. times This inspection does not=Mress haw the systemwill performs in the facture under the sane or dilljerent cowNtions of'use. Title 51nspection Form 6/15/2000 page 1 Page 2 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 663 PopponPSGPt Ra Cotuit MA 02635 Owner: Paul J Knight Date of Inspection: g 111 f S Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D A. System Passes:I/ES NO 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: Septic zyztem Liz in pizopea wo2k.ing olden at' the pnesent -Lime., 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. NO The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. # .ND explain: NO Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: NO The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 663 Pnppnnc---GPf Ra Cotuit 4A 02635 Owner: Date of Inspection: R j 31 f p s C. Further Evaluation is Required by the Board of Health: qES 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 environmenf. 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: F no Cesspool or privy is within 50 feet of a surface water no 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: 10 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. n o The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. no The system has a septic tank and.SAS'and the SAS is within 50 feet of a private water supply well. no The system has a septic tank and SAS and the SAS is Iess than 100 feet but 50 feet or more�frolb a .private water supply well".Method used to determine distance v i z tLa Q "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: qa2&aye dizpozae .is P2ezeat with on 1-1000 ga01/nn Ap-lo _ r .tank. Page 4 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �. CERTIFICATION(continued) Property Address: 663 PC)P nnPRspf Rd Cotuit MA 02635 Owner: Paul J Knight Date of Inspection: 8/-i i f n S 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 - 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 1/i.day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below Ngh ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X . Any portion of a cesspool or privy is within a Zone],of a public well. X Any portion of a cesspool or-privy is within.50 feet of a private water supply well. r . 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 form.] NO (Yes/No)The system fails.I have determined that one or mom'of the above failure criteria exist as M described in 310 CR 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. 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 X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone iI of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 663 Popponesset Rd Cotuit MA 02635 Owner: PaLI 7 Kni Qhi Date of Inspection:A.3 1 /n 5 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? 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: Yesp — 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)J Page 6 of 11 OFFAL•V4SpT N1,V.Q 'N DT FOR V4QLMMI RY ASlSOS IF'S � S 5 WAVE-W.W.AGE D1 a'AY NL. $EC PART:C SYSTEM.W0R*An1DN PropemAddresS: 663 pnni nnaccc� DCt Owner: Paul Date of Inspection: R/ •/ kt W CONDM- ONS RESIDENTIAL Npmberofbe&==lsct Number of De�iraams(tic 843::,�:: 0$ r 0%aini a 'I IW d it#•6fbedrocfms �`3 3'0 ` DESIGN flow ba§6d bin 310 C1VTlr. { pY . Number of Current residents:.,2 der or no w L7oas residence have a garbage grin (yes Z is lalmdry.on a separate seweyge.system(yes or.ntl):n o Elf xes separatetipn required] . Laundry system inspected(yes or no):n b r Seasonai act(yes orno): •a0 2003=68;.0.00 gai-eon�s '[7=186. 30 Watci meter readings,if available(last 2 years usage(gpd)): -(Z�- 6. 0 0 0 ga o n qr �=T 5 3. 4 2 Sump puma(yzs or no): n 0 Last date Q occupancy: C0M MERCW.T&USTRL*L N!/I , Type of Des flQw. " '' on•310 CMR 15.201):. apd' Basis.of s ign Ilow(seatsfpMongsq%otr..):; Grease tra}tiresent(yes or no): - Indust.al waste holding tank present-(yes or no): Non-sanitary waste discharged to the Title 5 system•(yes.or no).„y Water•.meter readings,if available: I.asrdatc of occupancy/use:;,� ' QFNERA,L INFQW.I ON Pumping Records r Source of infonnation: , Was system pumped as part of the inspection(Yes or no):, If yes,volume pumped:10 0 0. PI1oAs.--How was quantity pumped determined?m e a.u a e d Reaso.n for.pumping: TYPE•®F SYMEM •. X Septic tank,dim-button box,soil absorptign ayslem ~ —_Single cesspool _Qverflow cesapabl • . . —privy on records,if ais _Shared system apes or no)(if yes,attach previous insPr�ti Y) _Innovative/Alternative technology.Attach a Copy of the current operation and maintenance contract(to be obtained from system owner) y —Tight tank Attach a.copy.of the DER AMToval —Other(describe): Approximate age'of a17 components,date installed(if known)And source of information: �eachin Were sewage odors detecttd when arriving at 16 site(yes or no): n 0 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �- PART C SYSTEM INFORMATION(continued) Property Address: 663 PoRponesset Rd rnf 1i t MA 02615 Owner: Paul J Knight Date of Inspection: g 131 .j45 TIGHT or HOLDING TANK: NO (tank must be pumped at time of inspection)(locate on site plan) Depth below grader - 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.): %.ight o2 ho ed.ing tank.6 ate not �2e�ent DISTRIBUTION BOX: y e-6(if present must be opened)(Iocate 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.): Box -iz ievee., Ras No ]soe.id ca2izy ove2 oz . eakage .in oa out o� &ox" PUMP CHAMBER: n o (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.): Pump chamgea -is not /wheat Page 9 of I I OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 663 Popponesset Rd Cotuit MA 02635 Owner: paw J Kn;abb Date of Inspection: _ R/31 /_p,_5 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located zee 12age 10 Type , leaching pits,number:_ leaching chambers,number: leaching galleries,number: X leaching trenches,number,length:2—3 0'X 2'X 4 Ieaching fields,number,dimensions: overflow cesspool,number: -. k 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.): Loamy to medium sand No z igaz o e ea.i-euae • So•i.9.6 ate dau - Vegetat ioa -iz norcmai,- CESSPOOLS:n o (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): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Ceps-6poo.ez ate not R teherzt 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.): �2-ivy �.� not n2e�ertt • Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 663 Popponesset Rd Cotuit MA 02635 Owner: Paul T Kn i gh� Date of Inspection: 8/31 f 0 5 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks.Locate all weUs within 100 feet.Locate where public water supply enters the building. F Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Grp PnnrnnPcct- Rd Cotuit MA 0_2635 Owner: Paul ah t Date of Inspection: 8 31 /0 5 SITE EXAM Slope Surface water . Check cellar Shallow wells Estimated depth to ground water o�feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: y e.6 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:aAs lai.P cr72 _ n o Checked with local excavators,installers-(attach documentation) ®ccessedUSGSdatabase=explainAttn:town.,Iazn'.sta iP-1ma.,u�s You must describe how you established the high ground water elevation: /1,3ed • CaRe Cod Comm-ia.ion !datez Takee Corit0u)E6 And Pugi.ie Wate2 SuR/2.2y Oete head /22otect.io-n a2eah mal2o Seat 1995 �a�e2 Zehouzces of�.ice ca/2e cod comm.ie.ion., Top of n Leaching Pit , Groundwatez' Feet Below Bottom of Pit High Groundwater A0justment I.8 ft per Frim to e. ._ .1 p p r Method Therefore,the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is - (� feet. •T[[.[1T/r[errsr-`rT�sr[c�aer>rTtCS[s'T[rrasrn .. T=ar.['R xneT.ser. , TURN OF BARNS, BT.F. WARD OF HEALTH SUBSU11FACE SFWAGR DISPOSAL SYSTEM INSPECTION FORM - PART D`- CERTIFICATION T[RAT'S::TAT.T[T.��'l'[.T.T[[['[JRSiTRYi'.'FSTfS•�.T.T7T,—t'T!"IRTRTl371liQr'y'�tLTi 7t[R ,T[^rV„'T`�tt••• •� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 66:3 Popponesset Rd Cotuit ASSESSORS MAP, BLOCK AND PARCEL # CCAO OWNER' s NAME Pei}1 } Kn i qh f- PART D - CERTIFICATION I NAME OF INSPECTOR Rogent P ao�ein.i COMPANY NAME go.seph p.' Nacom&e2''FT Son Inc COMPANY ADDRESS Box 66 Cente2v44_i& Na.&.s* 02632 Street Town or City State LIP COMPANY TELEPHONE t 508 1. 7.75 -. 3338 FAX 4 508 D790 - 1578 CERTIFICATION STATEMENT I certify that I. have personally. i'nspected the sewage disposal system at I address and that the information reported is true, accurate, and omplete as of the time of .inspection - The inspection was performed and any recommendations regarding upgrade,. maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems [ Check one: ' . e ��System PASSED + The inspection which I have conducted has not found any infdrmation which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR. 15. 303, Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con meted has found that the system fails to protect the jiublic health and the environment in accordance with Title 5 , 310 CMR 15 ,303, and as specifically noted on PART C FAILURE CRITERIA of this ins ect ' on fc.r f"w Inspector Signature Date ' Ywnecopy o£ this certification must be provided 'to the OWNER, the BUYER re applicable) and the 13PARD of HEALTH. * If the inspection FAILED, the owner or,,,operator shall upgrade ' the evRtPm q 0 OAT PROPERTY ADL)RESS 663 Popponesset Rd Cotuit MA 0263.5 . On the above date,the: ieptic system at the address above was Inspected. This system consists of the folloWing:. 1.� 1- 1000 gaMn. zepuc tank.' 2.� 1-Di6ta.ikut.ion box.' 3.! 1-1000 gaiton 2each.ing pit.' 4.t 2- Leaching tnenche.a 30'X2I X4' Based on inspection, i certify the following conditions: 5.� 7h.iz .ih a 7.it ie Five Septic a y.5t em.' 6.. Septic hyhtem '.is in•- pltop,eit wozk.ing oadea at. the n,tez rtt time. SIGNATURE, . Name: Robar#A. Paoitrii Company: JoMb P. Macomber Address: P. Q=Box 6s* Centelvllie, Mess Q22 Phone: 508-776:=e or IQ*775-_ 412 j0SVH P. MAACUSER & SON,INCW. TankaCeupools�te�ctifield: Pompgo&.1ad fled TOMSewer;donnebtlons P.O. Box 66 Centerville, MA.026.3z-0®66 77S 31$ .' 77.3.6412• ' s TOWN OF BARNSTABLE LOCATION 461�3 16ngm CSS0 % SEWAGE# VILLAGE i.f?Tuf ASSESSOR'S MAP& LOTIOQ6" 001A INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 40 6 O 60 LEACHING FACILITY: A1 4size —3d day NO.OF BEDROOMS BUILDER OR OWNER/ rn r6r11 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 feet of leaching facility)) Feet_ Furnished by &41 �9ro�e l d 3 ae � �, 33 ' , t ASSESSORSM914 G36� No. � `�' PARCELN0: Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipprication for Migpogai bpgtem Con.Mruction Permit Application is hereby made for a Permit to Construct( )or Repair(k'�an On-site Sewage Disposal System at: Location Address or Lot No. C (3/ fal ®n ess e�� Owner's Name,Address and Tel.No. j Assessor's Map/Parcel Cd�j ,41// jr/7 fo 614 7- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 60®._.e24,7 �� Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Na re of Repairs or Alterations(Answer when applic le)U C— ✓✓O " _nf Zodcm.W-;�;14p, `.�,r x 30 leAcH—Veeaees c,,,T s%d 7 c eon,, 6, �V.3 5,1a7c ol 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 d by this oazd of Signed Date u .d 7 19,76 Application Approved by Date �a f Application Disapproved for the following reasons Permit No. 16 Date Issued ——————————————————————————————————————— No. THE COMMONWEALTH OF MASSACHUSETTS -... PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migogal bpgtem teuwuctton Permit Application is hereby made for a Permit to Construct( )or Repair(k'�an On-site Sewage Disposal System at: Location Address or Lot No.6�3 .� O/1 e Owner's Name,Address and Tel.No. -�- O .Sf��0 Assessor's Map/Parcel, �U/v jT !iQ(// J 1 16�'� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �J- Lio Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow . gallons. Plan Date Number of sheets 1 Revision Date Title w Description of Soil 1 `� k M Na re of Repairs or Alterations.(Answer when applic ble)Im 6 O C-' 1> >O .t"r1T�� 4od69� Ail f Pnc �S G�„ l ol''s/l r)e Cpvice.,7 !�� '57o 7C ry 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 d by this oard of a fh. Signed Date 'a7 197P " Application Approved by Date F`;W _ If", Application Disapproved for the following reasons s -Permit No;- /4 / Date Issued ' ———————————————-——————————— ------------ THE j COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance J THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced(k on by Ins er Go repo j-7",)1 VJ at G CAI 0 e 'Ke"'� GG has been constructed in accordance with the provisions of tle 5 and the for Disposal System Constru tp Permt No. .- dated f,97- q� Date Inspect� 72 '+ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. No. l isr " Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION . BARNSTABLE., MASSACHUSETTS i Digpogar *pgtem Conotruction Permit Permission is hereby granted to G o 2- _73t_ ✓h v s to construct( )repair(p�an On-site Sewage System located At No.# 66 Sa�an rs�c7T —Co/� Street and as described in the above Application for Disposal System Construction Permit. No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed withig three years of the date below. Date: � � '��~ ' Approved by !� Board of Health pit f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated >j Q, b , concerning the property located at ne,53e - Vmeets all of the I following'criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase inflow and/or change in use proposed • There are no variances requested or needed. SIGNED )SE: DALICENSPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER- [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1A17 o \ I �d5, 6 o 9 CERTIFICATE OF ANALYSIS Page. 1 Barnstable County Health Laboratory �eHu. Report Prepared For: Report Dated: 06/03/2002 Order Number: G0214717 Paul J.Knight 663 Popponessett Rd. Cotuit, MA 02635 Laboratory ID#: 0214717-01 Description: Water-Drinking Water Sample#: 14717 Sampling Location: 663 Popponessett Rd.,Cotuit Collected: 05/30/2002 ollected by: Paul J.Knigh 006-022 Received: 05/30/2002 Routine ITEM RESULT UNITS MDL MCL Method# Tested LAB: IC Lab Nitrates <0.1 mg/L 0.1 10 EPA 300.0 05/30/2002 LAB: Metals Copper 0.1 mg/L 0.1 1.3 SM 3111B 05/31/2002 Iron 0.3 mg/L 0.1 0.3 SM 3111B 05/31/2002 Sodium 3 mg/L 1.0 20 SM 311113 05/31/2002 LAB: Microbiology Total Coliform Absent P/A 0 Absent P/A 05/30/2002 LAB: Physical Chemistry Conductance 59 umohs/cm 1 EPA 120.1 05/31/2002 pH 6.2 pH-units 0 EPA 150.1 05/31/2002 Note: Based on the results of the parameters tested,the water is suitable for drinking but may present aesthetic problems(taste, odor,staining)due to Iron. Approved By: jc�-..,-•�--- (La//b Director) (v/7/ZddZ_ i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605