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HomeMy WebLinkAbout0009 TARAGON CIRCLE - Health (] '�l'�]v� d y (.tfiV4 D �lr�:��xf'a �" ^y14x l y•.. � z,�a tM^��t'h �♦♦ ii�gl'i��p Zy.t}t�,4. 5�?k��n.��- "�.�r� �_�.�'�''�� �, p 4 ;1 .> � ii���. Z1�lw'y�3 ��n'�, �R ��tr�y��i�. a:?`, ��*,a�•�,i x #xl' 4 �. f ..A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection Inspection results must,be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return i - Name of Inspector key. Cape Cod Title Five my Company Name Company Address few 6 keefe crt ma 02632 City/Town State Zip Code Centerville S 0 -3 2 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 6(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/24/13 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Tfile 5 Official pe n Form:Subsurface ge/,sosal Syste age 1 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This system is in good operating condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please,explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or 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. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due- to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or,obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): , ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board.of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either" r" "es o no to each of the following, in addition g y , y y g, addlt on to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , y 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9124/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® 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? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? . ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ 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(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system Passes and is in perfect working condition. Consisting of a Tank dbox and fully functioning SAS Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage 28,000 2011 And 9 ( Y 9 (gPd)) 27,000 2012 Detail: App 76 GPD Sump pump? El Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): General Information Pumping Records: Source of information: Home owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 23 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8x5x4 Sludge depth: 3„ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 18"s Scum thickness 3"s Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 45"Sludge stick How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All Components are in excellent shape Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is Cotuit Ma 02635 9/24/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 9 Terragon cir Property Address Richard Gallagher Owner Owners Name information is required for every Cotuit Ma 02635 9/24/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is required for every Cotuit Ma 02635 9/24/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, . etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 " EXCLUSIVE EROKAGE PAGE 11l12 - paga 10 of 11 OMCUL'NSPECDON FORM—NOT FOR VOLUNTARY,SAS SURSUREACE SEWAGE)DISPOSAL SYSTEM INSPE N� PARS'C CT�TON FORM SYSTEMINFORMATION(continued) PropertY Address:9 Tarragon Cirajr Cotuit Owner; Virgitga GitlPn lute or lnWetion: August 24,200G SKETCH OF SEWAGE IHS"AL Sy9Mm Provide a Aketch of the sewap disposal system including ties to et loast ttivo benchmarks.Locate all wells within 100 fmt.Locate whem public wateir supply enters the bbuildPermfmcnt ing drnArks or Tarra on Circle riveway t Water Service d' Y Y A 34 25 40 3 49 45 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is Cotuit Ma 02635 9/24/13 required for every �I page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar Shallow wells Estimated depth to high ground water: 24 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Board of health prior inspection report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Topigraphical map of local area. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 9 Terragon cir Property Address Richard Gallagher Owner Owner's Name information is Cotuit Ma 02635 9/24/13 required for every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Li r 4 —14 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 0/v� -Oa Property Address: 9 Circle Cotuit MA 02635 Owner's Name: Virginia Gilligan Owner's Address: Same Date of Inspection: August 24,2006 Job#06-222 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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% V11111 _X_ Passes y�° • '�C+'�� Conditionally Passes ' PAT IC Needs Further Evaluation.by the Local A proving Authority _ ...;m Fail s ,C .; Inspector's Signature: Date: 8/24/06 �F5 INSPEG� i The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heait// I IMM 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: Leaching pit has 16-18"of standing water,tank is not in need of pumping at this time. ****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. j C Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 exfiltratiori 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 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. 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: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 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_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. 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 form.] _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: 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 _ 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 1I 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:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 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: 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)) r Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):220 Number of current residents: 1 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): Two years total:54,000 gal.=73 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL 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: Tank pumped 6-7 years ago. Source of information: Owner 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 _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: 1991 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X-40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 18" 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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tank has liquid only,no solids.Tees are intact and clear,liquid level at bottom of outlet invert 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.inveM evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 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:XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): No solids or hiLyh stains present. 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.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. 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.): Observed 16-18"of standing water with no high stains. 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): 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.): l Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 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. Tarragon Circle Driveway Water rvi Service 34 25 40 32 49 45 Page 11 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:9 Tarragon Circle,Cotuit Owner: Virginia Gilligan Date of Inspection: August 24,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 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: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.35 and topo map shows property above el.50. w '""' D�!TOWN OF BARNSTABLE 1�'OCATION �%` SrWA-CtE# MO7f -VILLAGE, Ocgvst ASSESSOR'S MAP&PARCEL�'y� - D/A r: n IN&TAU.9M NAME&PHONE NOr.�s*ri��c SEPTIC TANK CAPACITY /Uw LEACHING FACILITY: (type) 1`tr (size) 1000 C ct-► NO, OF BEDROOMS OWNER 1 jnie;% PERMIT DATE: C 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 feet of leaching facility) Feet FURNISHED BY 7arrnoon Circle. ! �dvoway v ' Water:;ervlce . ''`I$` tii"G:i�?>iiz-!-'»> »i," iJ:'•i''i4' i%% iz-iiii 34 40 t 3i / 49 AS l TOW =BRNScTABLE A�") LrJCATION SEWAGE VILLAGE �t1U� ASSESSOR° M P L T OOIJ SDI a ��p, INSTALLER'S NAME & PHONE NO. �10 �7� a�QO _SEPTIC TANK CAPACITY 000 LEACHING FACILITYAtype) / A (size) do NO. OF BEDROOMS C;2 PRIVATE W LL O PUBLIC WATER BUILDER OR OWNER (,0'v5 DATE PERMIT ISSUED: a DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No • � �� �r ` ,��+ �� Y No.- .. Fim$.... �... THE COMMONWEALTH OF MASSACHUSETTS -tY'(IF BOAR® OF HEALTH ® ROBE 1.0�'. ................... l Y•`•�� O�"`1' U�Z Ob E . OF................... 13-.... ................-------- . ppliration for Disposal Works Tonst `union Prrutit 5 � n is hereby made for a Permit to Construct ( I-or Repair ( } an Individual Sewage Disposal 0 . ..... .x_D .19 L_V rF :P vt r 1,0.1. ... P...4"/. _....s41 E�•_1 07e..e...... � /r Location-Address or Lot No L Owner Address a ...... ....... •. ......... ......... _ ._..... � Installer ,�. Address Type of Building Size Lot.... 4 ,5..Sq. feet Dwelling.—No. of Bedrooms.............. ..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ________-___•_______________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures •-------------------------------------•--------------...----•---------------------------------------------.....---...-----------...-•-•...--•••-.•---• W Design Flow.................�.....................gallons per person per day. Total daily flow------------------Z.�.�_.__...............gallons. �I__.a r W Septic Tank—Liquld capacity.):�.gallons Lengtht�-�?..... Width.4... _"_ Diameter................ Depth..5_".�-:_. x Disposal Trench— 1No. .................... Width-!.._...�____-__-- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....... ............. Diameter...JD.^4---- Depth below inlet-.... .... Total leaching area..O�v�!6.%.RtP Z Other Distribution box ( Lj- Dosing tank ) y '-' Percolation Test Results Performed by.. �D.__ 1��� hlG_-1-(�C� Date... _.Z -.L 1_J. ..__.. W Test Pit No. 1......4------minutes per inch Depth of Test Pit----I ......_____. Depth to ground water_ .......... fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ---- .... t --p r..................r - •-- Description of Soil--•_� 2 ..--•_.. F�,,e, J. `t�Jy!� ... x W --------------------------------------------------------------------------------------------------------------------------------------------------------............................................... U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. -•------•------------------•-------------------------------------------------------....------------•-••--•-••-••••-----...•.•---••-•--•--------•-•••--•---............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI,1, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b the board of lien th. Signed -® ----- ¢ � Application Approved By...; llelv,; .. Application Disapproved for the following reaso" ---------------•-- --------------------------------------•------------------------------•-•----••---•--- Permit No. -- Issued -Date Date No.2•-'7.L4 -- Fas.../.. .. THE COMMONWEALTH OF MASSACHUSETTS �EF�q BOARD OF HEALTH Jr..............................O F.......... ? 1' %a " R 0 D 98 �plifiutttion for Disposal Works Tonstrnrtinn ramit +oHAL tion is hereby made for a Permit to Construct ( -or Repair ( ) an Individual Sewage Disposal ........ �/ /lL..+J�TFy-�/:`l�J GI�r •�Mdi i � "4'+ ..... .. .....-.�............. ........................�..._--..l.................... ................... ......... ....... .. ...._................... r Location Address or Lot Nq + e VI _ i .4_.. .........................................� . � 1I� t", �_`s �flJw _j •1 ' Owner Address iGr G W � Installer Address Q Type of Building - � = Sq U ,i,P g � Size Lot___.�.�__:-____�...>__ feet �-, Dwelling—No. of Bedrooms.............. _...........____.._...Expansion Attic ( ) Garbage Grinder ( ) a � lather—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) - Other fixtures .. W Design Flow.............:.. a.....................gallons per person per day. Total daily flow-.__-------._.__. Zq..._..._.......gallon WSeptic Tank—Liquid capacity_10•'0..gallons Length�;r.-ee.`.'... Width 4_".1P___. Diameter________________ Depth_.; _.`A-- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._.__.9............. Diameter-_-b `-0 -. Depth below inlet--_. 1�%-:'__. Total leaching area.�42.'.4-..gq.RtL Z Other Distribution box Dosm tank ) �, '-' PercolationTest Results Performed by._ _ ' la ........................................�rel� Date.. _3 l l f a ...... Test Pit No. I.....Z.......minutes per inch Depth of Test Pit....2............... Depth to ground waterR?"11.0--_________- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water____--_-_______-----_-_. Fri I .......I * .....................rf _.. _.•. ---•--••----------.....q. .____- .............. ---------r' "'... -- .O Description of Soil... �.---••----• ¢ -------Z--- �a..---•---�z--•-- U ..............................•••----•-----.....___.....____----..._---------......_.___......._.--------•--•---•-----------•'---------•-•--------•----••---......._.._...._.____.._....____•-----------. W M ---- ................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ •------------------------------------•---------...-----•--••----------...----------•---.......--•---•-----------------------....---------------------------------------............................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuel>the board of hea th. ,r Signed.........•--------- ------- ----- - - -...Ijg....•- Application Approved BY......  ................. D e Application Disapproved for the following reasons' Date Permit No. 1�i .. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... .................OF., ..Ar .: �2!::`. ? >.'- :....................................... Tntifiratroaf �nnt li nrp THIS IS TO CER� , That the Indvidual Sewage Disposal System constructed ( ) or Repaired ( ) bY-------- P-0------- -S C�? -.......................................... . --- ........... C i �,� n 1 at----•�-�-!---•-�-•-••--��, .......>a/ _ ....��., .1%.�.•---••--- -•;----- .:�..._l/.l-............................ -----------•--------------- has been installed in accordance with the provisions of '?-1 5 of the tate Sanitary Cn e l bed in the application for Disposal Works Construction Permit No._•. /_.+ __ � ----• dated THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A RANTEE HAT.THE SYSTEM WILL FUNCTIONISATISFACTORY. 0 0 DATE......................... Wo IV................................. Inspector.,.. ,� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L.- A / r-� r. Imo' ! �. OF.............'.......... .) ,..Z 4� No... .......... ... FEE.._ _............ Disposal?,41 nrkii T s inn rranit ...Permission hereby granted ._.... •. •.---•- o to Constr ct orfepair � V n I ivldu 1 Sit- rage- is sal,�`�yst Street . . as shown on the application for Disposal Works Construction Per it l�Io._ _ .'�_.. __ Da? __`�._._..-.•./_`._.. ---------------- -----.--- .. .---•- r -£ ! J Boarrl-.--of ealh DA TE ------. t{ �( .............. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r / , 01_sAt ;.�iy� ,�� - is :.*'^` 3 h.rr � .�i'('�: y"• �• +yrT g=•,b E'�'�'X1 •���Y 'x3•'.�iir.= ., . M1_ ,.,. _ S :� :it ..,fa � i �.i' 'ry eft -_ ti' r�4 � ` - ���. .� ' 3 d,� y )),y L' ��' 7 -�.irS- ,�t �-"s. 'e^c°•�i- ;;r.e 4�� p, x _ _ ''�+ss yp --y _-F r -�- 'i';-' 11� r;'� �� .�=i"'. , t- �rr •. .��r' �» � _ T�''" V'J� � fYYwx.a,.s �rr.- ; ..s �• �', 'xi',. �i.Lf�r��, ',�� - �- �.n7-�,.,v= �1�� :+l'f 2 a;�,_;�`-J'1 A•' _ ��. e�_ �',r "l ry.4 �•,. .sfa-Y- <';_ � .�~'��.. 'Sa�F��.=+t_ 9 '" 'a - ,F-=-•.. t-• : ,7�,:. ' ofi�z,.d; - " :r• .. 'S•, _ � ~ ,.�'i S'"�F� s -Y'2 .+. 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MEDIUM _ �h� �.�(►.�e a k -'-I t-`! f. .� •` { ' �,, .\)ADING`' SAND i 14., � + 1 4 i� lG7 {. x. { �. ._.M�tV - Fi' .,_ W�}L-�`F�✓i T"'1 �.L Y�<a r � '�3 '�T ... 1- ..1� -� I � ^�5.. FA y,. t 1 t �: I _ r•, 7,f 1 +•� ' t �+"+i7 \�,' h E - ~t1 iNV'I�..RI 4.L. 1 f 9 PI ", ii L. L/3 T RI B1U ' ON BOX _ R ;Y i w AN-? R;� r 47.5 } N4 F [, ST'RIK ' �> r TOWN OF BARNSTABLE NO WATER ENCOUNTERED n c r'. 1 .. �')Al. RE' J O-Rt . ,F' TANK R`�' a� OBS • VAf 0iN c'aT T�''1�ICAi 1000 S , i Srti, T.�,114K A�:MF per: „�t_ w _,F � ,�.� 10�0 E T �'PIC LEA NCB PI T '.?N kATE' = > 2 min/inch Vt?T 5� -:,_f- / aT SG4� : ; tiAL_L 13 iI`S 1"�_ `JY e �`` EDWARO :V• T T.Qtih� F G k0U �U . WITH, ', S BARRY � � 'l F NOR EO T-i GNP r � 4 - �rn BARNSTABLEtl;^ . riEAITW Ei :ITS'^ INELDf.} 1►M RE W�TrS 24--i%�" : y+is. � $ r,m y y T, < ARO ENGINEERING INC. E M661_ .l ROD' 'N TOP B BOT i r FEBRUARY 28, 1991 TON' ON ,RE Tt 4;.ariC, IDS I _TA _._ R 'r�. r r ' } t�" 1 ! iwt I t z t:iJ <6Eri 9F TWA_ �� g u; J Yfj 8F, H{.i?3W lIn }I t,�A UE I tJ p \lF 10, NORt fl A Rt . Y!,l 1�.'L t-i.;,T L.,Lf �`tif+� .�/i._/��l f ,�• i �, h. 7, ptt} FOUNDAT,��N, ELEV. '7t0 ,.�.C+AJi.''•�.y ,-;-� -i� �-, ,,. i iC 'r,r a. d - 1 ' I.J• .. h' e•_ ,3'i _,'"i 1�=e..... ! .) R .S'•F<.i.A..±+ t_j" 1-. n,- `I.NISH GRADE C)VER Ti;NK w ' r ,:k, 59.5 E LE`J 63+0- k GO+!� ` t t +k ,t y.,. *`.�}. ^�'v 4�r'J• ,�, _ Iw �4 1 . °J // tit• ll � -d - - {� .� • .� ,.t✓S •';+*.,^� .,,,.ty,r •T: •�.^s-m:,.-t-\Y,tRV r� T - - 59.04 /000 , 4 -_ ,_...__._._ .. ..� -. .__. ..•.+-._.. .,,..- fit' 58,55 - , - 58.00 52.00 Coy, � 21-01, 024 TYPICAL SEWAGE SYSTEM PROS I LEi � g d 3p0.0 1vV g� D J�.G� H. , >. - arr m 645*' \ f- _ la � r 4 0 .a 41 _ G) F ROPC5F'D .:; .a 'rij �S •. _. �co : i A P6 R•wrt,l t_ T i eP,t L C..t - < _ Le. •^ r_.',�._�._.. _ _ ...' +.-t r_''__. "'n `'y_ s ,._ ":, . ,.- #� R ' 14 .4 �fl• PROPOSED �/ T ODWELL.ING !'' 1 t ,\ �� / ,r� •-...,,,,....�•..ar.,,.... ..••-°.•-wrr...+.•.w.++r+r ....++.s+.r,....w. .....w..-......_..r,.«-.•,.w.w.��......,._.._.,. w__ .,. .,. I ` } Cn TUI PINS 36. 74' _ t e�}Pq L. J t f �.� f /"\x Y :4 [` G� . YCIVIL �"'J"-51 t 1, M DE7Si N GRITER,,4 �� , oPC) �, __ R, � e.ii� �` � �. . � � w �� _ I � M1N0 \ \I Q !'' »......,.•...•..:_.-..._...-.,,.......,......owy.�.+,..,_.___ �'.�6aG� rti , � .� i PIT � � N, L (� a�9` .:+7�' !�,M' RM..rtTT S.,k 2 E RS0N �- . � LOT � . J .� . I FOX DEN BLUFF ROAD a 71 N o° ! GALLONS Y .R C>N R DAY ^.& ��y.� > 42 IZR - COTUIT �, --- EACHING' �OFQ ii RE 22OVd BARNSTABLE ), MA. " x DEN BLUFF \ ' ACHING ► 7': IY i�E., 549e gpd ROAD No eRctA ,, Ve-# r 3 i !;' 1, fl THEO CONSTRUCTION CO. ARO ENGINEERING fN . SEWER A '€ 24 GREAT POND DRIVE 39 STRIPER LANE S. 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