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HomeMy WebLinkAbout0123 TROUT BROOK ROAD - Health 123 A pQ8 006 t �_+•'I ,F 1 i I� 1 ep 08 1503:47p p,1 ODD-ago Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r+1 '1 123 Trout Brook Road Property Address r.., Albert Hanwell Trust L Owner owners Name , information is Cotuit r MA 02635 94-15 required for every � •�� page. Cityrrown State Zip Code Date of Inspection Q Inspection results must be submitted on this form. Inspection forms may riot be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ///�� „�pNnUnrur�r on the computer, / `������`�yk Or use onlythe tab / ��� - `s 1. Inspector: �44 ' syc,,� key to move your . cursor-do not James D.Sears _' JAMES n key the return Name of Inspector CapewideEnterprises LLC 's o ,o Q i Q Company Name �. l ••;�T►F���. 153 Commercial Street INSFEG����`�� Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 94-15 pectoes 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. it t5ins•3/13 - Ttle 5 Official Inspection Form:Subsurface Sowage Disposal System-Page 1 of 17 �d vs Sep 08 15 03:48p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. CitylTown 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: ® 1 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: The system is a 1250 Gal. Tank D Box and two pits. 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 exfiltrabon 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): i 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Sep 08 15 03:48p p,3 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 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(cant.): ❑ 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: i ❑ 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 15ins•M3 Title 5 Offidal lnspedlon Form:Subsurlaos Sewage Disposal System•Page 3 of 17 II Sep 08 15 03:48p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotult MA 02635 9-4-15 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 Ail System: 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 1 or clogged SAS or cesspool ❑ ® Liquid depth in aasspW is less than 6" below invert or available volume is less., than %day flow .4017,S t5ins-3113 Title 5 Official hspec ion Form:Subsurface Sewage Disposal System•Page 4 of 17 Sep 08 15 03:49p p.5 Commonwealth of Massachusetts VoTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 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. ❑ E 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. Ei ® 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 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—iWPA)or a mapped Zone 11 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. ,Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 17 Sep 08 15 03:49p p.g Commonwealth of Massachusetts Title 5 Official Inspection Form orm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owners Name information is Cotuit required for every MA 02636 9-4-15 page. City[Town 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? ❑ 0 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 CM 05.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins•3113 Titre 5 Official Inspection Form:substyface sewage Disposal system•Page 6 or 17 Sep 08 15 03:49p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1250 Gal. Tank D Box and two pits Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2013-229,000Gal 2014-0 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date CommerciaYIndustrial 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 i Water meter readings, if available: 15ins-3113 Title 5 Olridal hspedlon Form:Subsurface Sewage Disposa!System•Page 7 0117 I Sep 08 15 03:50p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 TPout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is Cotuit MA 02635 9A-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 VA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subaudace Sewage Disposal System•Page 8 of 17 Sep 08 15 03:50p p,9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address . Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-16 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: 1975 9-2015 New D Box Were sewage odors detected when arriving at the site? ® Yes ® No Building Sewer(locate on site plan): Depth below grade: 28"reef Material of construction: ❑ cast iron ® 40 PVC other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 20 & SCH -40. Septic Tank (locate on site plan): 18" Depth below grade: 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 1250 Gal. Precast H-10 Dimensions: i Sludge depth: 1„ i 15ir s-3/1 3 Title 5(ndal fnspedion Form:Subsurface sewage Disposal system-Page 9 of 17 i i Sep 08 15 03:50p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner owners Name information is Cotuit MA 02635 9-4-16 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cant.) Distance from top of sludge to bottom of outlet tee or baffle 29" t)' Scum thickness Distance from top of scum to top of outlet tee or baffle 2 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Tape-Sludge Judge Comments ton pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank and covers at 18"below grade. In and outlet baffle's. No sign of leakage or over loading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Hate - (Sins.3/13 Tice 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 10 of 17. Sep 08 15 03:51 p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information required For every cotuit MA 02635 9-4-15 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.): i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ms-3113 Title 5 Otfioel Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Sep 08 15 03:51 p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. CitylTown Slate 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 25" below grade w/two lines out. Box is new 972015 Wcover at 6"below grade. 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 Inspe:tion Form:Subsurface Sewage Disposal System-Page 12 of 17 Sep 08 15 03:51 p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessm nits 123 Trout Brook Road Property Address Albert Hanwell Trust Owner owners Name information is Cotuit MA 02635 94-15 required for every page, CityfTown State Zip Code Date of Inspection D. System Information (cunt.) Type: leaching pits number. 2 ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,.etc.): Leaching is two precast pits. Pit#1 at M' below grade w1cover at 16". Pit dry w/stain line at 18" Pit #2 and cover at 14"below grade. Pit dry wlwall's like new. 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 (Sills•3f13 Tills 5 Olroal tnspection Form SubsuBace Sewage D'6posal System-Page 13 of 17 Sep 08 15 03:52p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cant.) 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.): 15ins-3113 Title 5 Official Inspadion Form:Subsurface Sewage Disposal System•Page 14 of 17 Sep 08 15 03:52p p.16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N6 12' Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4-30-75 Date ® 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) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on File BOH 4-30-75 12' No G.W. area and lot high. ` Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.3113 Title 5 Of dal Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 I Sep 08 15 03:53p p.17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hartwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-i5 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 Ofridal Inspection Forth:Subsurface Sewage Disposal System-Page 17 of 17 Sep 08 15 03:52p p.15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 123 Trout Brook Road Property Address Albert Hanwell Trust Owner Owner's Name information is required for every Cotuit MA 02635 9-4-15 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties t at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building, Check one of the boxes berow: ® hand-sketch in the area below ❑ drawing attached separately 13 /.3-;2 3 '' 13-3 - 3 /'�,, f 13 1/ P'rl t S.Ds•3n7 IiW 5 D1Roe1 lr•spe[Don Form:Subs�Sewage Disposal System-Page 15 of 17 1` No. �. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTS es 21pplifation for Disposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ►Individual Components Location Address or Lot No. Z a3 TRO tW 04cOr- R b Owner's Name,Address,and Tel.No. Assessor's Map/Parcel f L 1 L HA Installer's Name,Address and Tel 140. 'O$ 477—91Z77 Designer's Name,Address,and Tel.No. �1:53�c�E P& WIA 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(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Sail _ Nature of Repairs or Alterations(Answer when applicable) =0 57*al O&Aj �d Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed , Date 5,-o-5 Application Approved by Date 2 Application Disapproved by Date v 'for the following reasons Permit No. ° Date Issued � � No. O t ) /' Fee o, y.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS '$es 110 2pplitation for Disposal *pstrm Construttion 3permit r Application for a Permit to Construct(j') Repair(W Upgrade( ) Abandon( ) ❑Complete System [Xndividual Components Location Address or Lot No. 123 T1R0 V?'13act0i:. R)h Owner's Name,Address,and Tel.No. Assessor's Map/Parcel nog 6 ([. t+JOCJb I 4,7-z►v MA Installer's Name,Address and Tel o. p.$ q77 827'7 Designer's Name,Address,and Tel.No. f Cgp�vmE CN�cPkcs��..�. Nl . Type of Building: n J Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ' No.of Persons Showers( ) Cafeteria(+ ) Other Fixtures Design Flow(min.required) IF A gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) =1Cl S-TW_L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. " i Signed Date `e��? �49 Application Approved by Date �— 2 Application Disapproved by Date fo{the following reasons Permit No. a-o ( —P Date Issued ------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CCERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CA P6..C,)06 u—g—e at 123 TRp u j r3 kno t< 'b CtJYI,)t T has been constructed in accordance � with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 I ''� 6 dated InstallerCAPEcWtbC C� £c �� � LLC Designer &j1A #bedrooms (/ /4— Approved design flow ��f�, gpd The issuance of this permitrshall not be Construed as a guarantee that the system •.iI.1-Nctil e igned. Date ins-ector � 5 2 (�'�"I ------------------------------------------------------------ ---� �-u-- ------- NO. Fee D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE,MASSACHUSETTS Misposal *Vstem Construction Permit Permission is hereby granted to Construct( ) Repair( x) Upgrade( ) Abandon( ) r--System located at f Rpc)T ll T h au t"i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Const ctionr}�ust be completed within three years of the date of this permit, nf Date��2�1/� Approved by fC r AsBuilt Page 1 of 1 Yv LOCATION SEWDCxE PERMIT 1JC VILLAGE 1NST&LLER S WOME hDDRESS bUILDER',SA Q &MF— P, b DDRESS DATE PERMIT ISSUED OATE COMPLI&KICE ISSUED': 4 r}CK G ar�IZ 5~�a 9 . G� i3 13 � �t2 h'e hd http://issgl2/intranet/propdata/prebuilt.aspx?mappar=008006&seq`l 8/28/2015 :k ---' -'--T - - -- M-E I� �I I ! I IT-I I ` I i i. �1 ' � i-� L, �•1 ; , I- -- , - �- � � i 1 � i All, I I ! 1. j I -:-, �-• I /----I I '. 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' ,_. ,-_ ' r Y I ,.:_l. .1, 'I i I—I I--; - - ��r J -L'o }- 1;1: I 41-4 n j1 - - .rOO�s. �I i+.y.-.fie_•-i--( I �-ice_ I ' �1 i I _ 1. _ � L , i • 1 1 f; i- I j '�^ � I �_.•i � + 1 1 t _i I i ��.� �J .t - t �-.__� _! -i-i .i-�y.�� fi(_� �I ..._ - �..... ,.._•-_-'� ._+.. I. 'I : I.I.-J J._ _I �_ i !—Iy _ 4-- I _ .1 , I I _r_ ,_. , 1 I I - ►�` I �l� '� i , rTK _ — ! T: T r - --- _ r- � + ;--t•-,•-� .�.� } I--i {yam- �I � �r-'- I ' {I'+ �-11 I _l__I F�_�' ! _�I -� -I--I I1 it ;. - -�-.'_-�-�-_-.�.:_. ' C.. _. �I' .yam'.' I �}fj•��l -1.�_ ! ,� I - �_f 1 I - + r ILIT FNvt '� - -• � � �» '� � ;„l�' .fir" �� �* 'Ar ,w � ><�'�'�"�,."#�'�'.e£; ��� ,�� *��y� � �. � ��-:. � �"� .rcA' "1 r ..r� ��' 3rz• +�'�4;��, -+'�,�,,,,. �,r�F = .' � t�`�L � �E' +�wr�t- _ _ AsBuilt Page 1 of 1 LOC&TION PERMIT 1UC VILLAGE WST&LL.ER S 1A&ME hDDRESS GUILDER'S 1U &ME P, &,DDRES5 LT DATE PERMIT 155UED DATE COMPLI&MCE ISSUED : �'�d_73' _ r'Y60, RXK C a/'�✓1 s http://issgl2/intranet/propdata/prebuilt.aspx?mappar=008006&seq=1 8/14/2015 b S LOCATION SEW&(:C E PERMIT QO. VILLAGE a o-Tu -jLr— — — — — IWSTALLER5 IJ&NIE � ADDRESS BUILDER 'S Q &MF- �- ADDRESS DLQTE PERKAT ISSUED '_ .J_3o`�J`J - - O A.TE COKAPLI W ACE ISSUED : _Z,10. 76 n 7z. No........ 'S`.....li'.,'k� Vol r0d� F:nc.....$.10.00........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _... ... . ........... .......OF......Barnstable Mass. .....• . ........................................... Appliratinaa -for Bhipoii al Works Totudrurtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: l d(/ TroutBrook Rd.- Cotuit Lot #2 8 "B=Lci=11 . -- Location-Address or Lot o. SEA-LATE_COKP.... P.O. BOX 264,..San-----•-ch,Mass. a N0.1= Awtte owner 176 Main St. , 9d1 ri&ich Installer Address QType of Building Size Lot------- 45_.._._.Sq. feet U Dwelling—No. of Bedrooms-..-_`_KQ-._____..._-•__________________Expansion Attic (X ) Garbage Grinder ( ) Other-Type of Building ---------------------------- No. of persons..__........................ Showers ( ) — Cafeteria ( ) Q' Other fixtures _____________ __ _____ ___ W Design Flow________________________________ �.-gallons per person per day. Total daily flow......�0d---------------------------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------/0j00--- Diameter____________________ Depth below inlet.................... Total leaching area------.._.- 1._ .___..sc ft. Z Other Distribution box (X) Dosing tank ( ) a Percolation Test Results Performed by.....Alan.W._-JQnes------------------------------------- Date__--.APB l 30,-- 1975 Test Pit No. 1----------------minutes per inch Depth of Test Pit..................... Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ---------------------------------------------------------------------------------------------------------•---------•------------•--•----------•-----•--.---- O Description of Soil.................. o ------------------- ------------------------- V --••------------------------------------------------------ .........................................................-----r- �� ✓'/ _ ......-•--•-•----•---......_........----------------- W —------------------- ---- -----------------•------.-.---•---------------------.-_-----•--•--•-----------_----•------------ �`� t.•'.t�.�— .............................................. UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in ,. operation until a Certificate of Compliance has been issued by the b rd health. Signed......... --- •-• •---••-------------------- - -•• 5..= -�....._ `-- Date ApplicationApproved By----- ��------------------•-•-----•--•-•--------------•-•--------------•--------------- ................ Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------••--•-------••-.... •-•-----------------------------------------------------------------------------------------------•-•---------------------------------------------------------------------------------------------•---- Date PermitNo........ ......................................... Issued........................................................ Date 0 ALAN W. JONES & ASSOCIATES CONSULTING ENGINEERS Carleton Drive East Sandwich, Mass. 02537 Telephone 888-3154 TEST PIT AND PERCOLATION TEST 30 April 1975 To: Sea-Lake Corporation Personnel Present: Paul Murray Route 6A & Tupper Road Norman Ayotte Sandwich, Mass. 02563 Alan W. Jones Re : Lot #28 , Trout Brook Lane Test Location: 100' into lot from Hillcrest Trout Brook Lane Cotuit, Mass, layout 010" Ground surface 110" Topsoil Sub-soil 1 0" Loose, medium to coarse, yellow sand; trace gravel and small stone 1210" O LA %i\a F No water encountered ml� Es ' Assumed Percolation. Rate: 1" drop in less than 2 min. /STEM Sl V'A�. Water levels indicated, if any, are those observed when test pit 'was excavated and do not necessarily represent permanent ground water levels. No......................... Fsa....$10.0.0........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ._. ---------- OF......In2 b] ,t..Masse ................. ............. Apphration -for Uhipaoat Norkfi C outitratrtioat Pumil Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: n n TrautF lc_. ..-..Ckytu .t. Iat-- 28 -- ................................... Location-Address or Lot No. .-------------------- -------------------------------- ...........Ps.4.---I=_264#--Saa(%dCh#1 .S,t.................... Owner Addre ian&ich Installer Address Type of Building Size Lot-----21045.......Sq. feet U Dwelling—No. of Bedrooms._.__TW0-----__________________________Expansion Attic (X ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ________________ _______ _ W Design Flow...................................... ...gallons per person per day. Total daily flow_-_-____-Ow>J..........................gallons. Septic Tank—Liquid capacit. ..gallons Length---------------- Width------.......... Diameter---------------- Depth---------------- xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-------119-OP--- Diameter.................... Depth below inlet.................... Total leaching area.-_-..-.-.---__--_sq. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by-----A3M-W.-_-67CAM..................................... Date.....A? 1975_ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--._--_--_---_-.__---__. Ix •---•-------- •--...-•---------------------------------------------------••----•-•-------• ---•----- .............. • -•--••----•-••--------------•--- 0 Description of Soil----------------•� ; ��st G �x 65 -----Iotom.--- �---6f,( -----•--------------------------------------� - - --------- -----••---------------------- ---------------- ------------------- ` =------------------------------------------•-----------------------------------��''� . r.c.....'... ....... ------------------------------------- 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 Article NI of tl"e S'ta e SamtarysCode The'undersigned further agrees not to place the system in operation until a Certificate of Compliance'has'been issued by the boar f alth Signed ` ---•-••---- - , __ .....---- Application Approved BY 'j� -- P Date Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------•-•. •-•---....--------- A� � ..........................................................................................................-_-__-_-__--___-___-___-_---____-___-__-_----__------_-----______-__---------__-___--_--------- Date PermitNo. ��--.....•-•-•-••--•---••--------••-•----........ Issued........................................................ Date' ^THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................P...................OF......................................................... ........................... Orrtif iratr of ' mphaurr THIS IS TO CERTIFY, That the individual Sewage Disposal System constructed ( ) or Repaired ( ) b ................. AA�.��l_A--------- �tl°fir ---------•---------------•--••---•••----••-•••--••-•-•-•-•---•-----------•--•••.... --- L 0 T' Gf1T_-. frb� Install v ear&/r —; at•--•---•-• ......... ............................ _.....•-•.......-•--•••... has been installed in accordance with the provisions of,Article XI..of he State Sanitary Code as descub6d in the,application for Disposal Work s.•Construction Permit No..:.:.::.: :.. . .................. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO RUED AS GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------— l� �­ C'6`------------------------ Inspector................................... ......................... /�•S,d' s' rAAX THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.._.................-----------...............--------..................----....... No......... ......... FEE.......................d Bi poii at a�rk� Cnnaa�triartt� t f rrmit Permissionis hereby granted - .........................I.........:................................................................................... to�Consfruct (,. or Repair ( ) an Individual Sewage Disposal System f/��E C S at . tiLG L"G ---- ----- -- ------------------- v/ I 7 3� as shown on the application for Disposal Works Construction Permit No........ Dated----- -----f---.- -•-•................•---•--••---•-----....----••---------------•-•---••-----•--•-•----••- -------- Board of Health DATE............................... ------------------------------------------------ FORM 1255 HOBBS &. WARREN. INC...PUBLIfSH ERS fir$.