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Home My WebLink About0036 BLANID ROAD - Health 36 Blanid Kb(} Ost ille . R A - 14 _060! , p } „ F , COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT7RE d RECEIVED �9�� Z003 UEPTABLE n TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 36 Blanid Road MAP ' Osterville MA 02665 PARCEL : Owner's Name: Thomas Fallon Owner's Address: 2 Tucker Road LOT - Norfolk MA 02056 Date of Inspection: March 5,2003 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: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: � /3� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments Precast Cesspool with Precast overflow pit. Older system but functioning properly. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2060 page 1 . Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A .CERTIFICATION(continued) Property Address: 36 Blanid Road,Osterville r Owner: Thomas Fallon Date of Inspection: March 5,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water Ievel 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: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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 l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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'/Z day flow X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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)] c Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 36 Bianid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 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)): 2001-67,000 gal. 2002-88,000=212 gpd. Sump pump(yes or no): No Last date of occupancy: December 2002 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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 None Source of information: Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped:_1 OOO_gallons--How was quantity pumped determined? Sight glass Reason for pumping: Cesspool Inspection TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _X_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: Cesspool is original overflow was installed in 1992. Were sewage odors detected when arriving at the site(yes or no): No Page 7ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 BUILDING SEWER X (locate on site plan) Depth below grade: 2' Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 25' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: Material of construction: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: 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.): GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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: I 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: No (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: 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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number: One 6x6(1000 gal) —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.): No excessive vegetation or ponding. CESSPOOLS: X (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with overflow Depth—top of liquid to inlet invert: 8" Depth of solids layer: 4" Depth of scum layer: I" Dimensions of cesspool: 6'dia.X 6'deep Materials of construction: Precast Concrete Indication of groundwater inflow(yes or no): No Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): No high water marks above outlet pipe. 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.): Page 10 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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. Li zc� 3s 1 �4l Page I I of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 36 Blanid Road,Osterville Owner: Thomas Fallon Date of Inspection: March 5,2003 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 ISO feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) X Accessed USGS database-explain: Town GIS and USGS topo maps You must describe how you established the high ground water elevation: Town groundwater map shows water below el.5 topo map shows property at el.20.Bottom of overflow pit 9 feet below grade leaving more than 6 feet of separation. L0' CATI N r SEWAGE PERMIT NO. 36 TV N VILLAGE I N S T LL R'S NAME i ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED ' DATE COMPLIANCE ISSUED �� _ � �- �3 �� gt `�' '� ! �� I � i I �., m----._.—.= ,r' c �- � � '� TOWN OF BARNSTABLE LOCATION SEWAGE # ' 10 c(Q VILLAGE � `� ASSESSOR'S MAP & LOT/ INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY eKII-1 iA. :2e-e-c,(45r` t t II� LEACHING FACILITY:(type) Pe-e�.rAgT V4 -•- (size) NO. OF BEDROOMS 3 PRIVATE WELL O LI____C WA�R� BUILDER OR OWNER ` DATE PERMIT ISSUED: -/6-2z#, qcp---1 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��j� J _. i i �,t • 4� �- � i o Z V7 �:� J'� R �� . '-- -� N v)\ � �•. �n � � .� � �. '�.�' 1�� . . ,�� _. �` 1L40— OaO `1 2 - 596 No........................ Fims.............. .-� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H E A L T FOarnstable CAPPR VED TOWN OF BARNSTABLE on" On 0"artment Appliration for Bi4pooa1 orkii Toa�otrur � rra t Oate Application is hereby made for a Permit to Construct ( ) or Repair (� Individual Sewage Disposal System at: .................. -4.... .... .....�-•--............... .....---••--------.....-sr............1--------.........--------------..-.......-............_ Loc ion-Address or Lot No. � CvL-•-------------------------------------- ----------- ..- Ownr -A �- eC_.................. ......... . �.. � `�n �. �'...--------- Installer Address Type of Building Size Lot............. .............Sq. feet U Dwelling—No. of Bedrooms._' _...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons____________________________ Showers a YP g ---------------•---••--"-"-- P ( ) — Cafeteria ( ) Otherfixtures ......_..---•----_..----•-•-"-""•-"----"----•------•--•----•----•--"-"•--------------------•--- ------------------ Design Flow_.__._____.,�,.�__�________________________gallons per person per day. Total daily flow.............._........____.................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................. Disposal Trench—No.____________________ Width.................... Total Length......... Total leaching area....................sq. ft. Seepage Pit No.__J------------- Diameter_._. _______ Depth below inlet_.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation.Test Results Performed by.......................................................................... Date"-----................................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a •••••-•---•--••-----•---••••-•----..._._..••-••--••-••••---••••--•-----...._•••-----•...•-••••-----•......................................................... 0 Description of Soil........................................................................................................................................................................ x U -•--•••••••-•••--...-•-----•••••-•---••--•--•-•----.....••---•--••.....-••-----•-•-•••---•-----•-•••-•-----••---•-••••------•••----•----•-•--•-••--••--•••••-------------------•--••----•--•-•---•---••- w x ------------- U Nature of Repairs or Alterations—Apswer m4hen applicable_ .7'_�F-cr, .___.�«)__.Q•! ._.d� _____________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been "ssu oard of health. _ Signed - . .... Y ------ D -Application Approved B =� re Application Disapproved for the following reasons- ......................................................-----------........................................................---------- 1 �' J��j/ Date PermitNo- -- ------------------------------------- Issued -------------------------------------- Dace 1 No....9.2.....�9r0 THE COMMONWEALTH OF MASSACHUSETTS , BOARD OF�,HEALTH TOWN OF BARNSTABLEe App iration for Dtinnsa1 Workg Tonotrurat n ramit Application is hereby made for a Permit to Construct ( ) or Repair �,�an Individual Sewage Disposal System at: ...............•-- ...�- .. iv 1 CX:....... ..................... ..................0 vv`.................._...._......... --....- - Location-Address or Lot No. -•-••--••-•--....-b!n:�•--- ........................................ ............. .........................................a................... Owner - A Installer d s i � Address UType of Building Size Lot............................Sq. feet �--1 Dwelling— o. of Bedrooms.--7-•---•----••------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ____________________________ No. of persons............................ Showers ( ) *Cafeteria ( )t dO{tther fixtures --------------------------------------•-------------...---------------------------.... ------. W Design Flow_._i....__�._.-::....................gallons per person per day. Total daily flow-- ....._._.._.............gallons. WSeptic Tank I Liquid capacity..---.......gallons Length................ Width..........--.... Diameter..........--.... Depth................ x Disposal Trench—No. .................... Width ................ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.....j............. Diameter....-- -......... Depth below inlet... . _......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water........-----........... Gr. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------•------------••------•---.....-------•---......................................................... W x . Description of Soil..........................:. W x ------------------------------------------------------ ------ •----------------------------- 7.........--•- ---------------- U Nature of Repairs or Alterations-Ar}swer Kh`n applicable.._S. -��. ._..--��-..P! ....� ' -----------------------------------------------------------............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agreesrnot,to"/place the system in operation until a Certificate of Compliance has been ssru'e�d_by-the board of health > Signed .. A.. .:: I .. .:.... ---".-'. M 1... ----� r G ........................� `A lication Approved B% `mac=M1C- , a? .. '2��f �7 2_ pp Pp Y ----- te Application Disapproved for the following reasons- -------------------------------........................---------................................................................... .................................................... .:................ .. ...................... .................. ................................................................................ ................. .................... �i ^1 '! `�� Date PermitNo. ......--_-+---/.......................................... .... Issued -:...--------------.........--........... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C6ertifirate of Toraylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired b C4 10-% --( _�4-v✓�....... �----I---all- -------------------------------------------------------------------------------------------------------------------------- ........... � � l�j at ...{...........�............. ...........................................- 0`�Zz`-u. ------ ------------......---------------...-- has been installed in accordance with the provisions of TITLE 5 of The St at�E vironmental Code as described in the application for Disposal Works Construction Permit No.�.......(..-..... -.......... -. c/ .......................... .......- dated .---.1....- -THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION STISFACTORY. ! 40 DATE................................ Inspector ' .......................... ......................................... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 —45-q� TOWN OF BARNSTABLE 3 No......... .............. FEE........................ Uiipuua1 Workii T-FaInstrudion ramit Permission is hereby granted........Gf ..........................C- � s �<::�..... to Construct ( ) or Repair ( y an ndividual ewage Di posal System atNo.•--•-•-••--•--••••-•--•----_....--_�%1. k .......................................................... S r t Street / � as shown on the application for Disposal Works Construction Permit No. 9 2_: __ Dated....... 2/Cl�y 2 v DATE. ................... Board of Health ti FORM 36508 HOBBS&WARREN.INC..PUBLISHERS f No....... `�_ � Of u� Fizs. ` :.�1P................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ........-----....O F....................................... Applir�ation for Disposal Works Tunstrnrtion Vrrmi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at r ,c'p -y - � -- ----. .----------- ... . .Gg Z:................ .....•.---..•....-- •-- •......... ........................................-- .. Lo ti -A ess or Lot No. . CL:•----------------------- ---- ......... -- -------- ---- - ner - � _. Installer Address Type of Building Size Lot............................Sq. feet Dwelling 44?No. of Bedrooms...3......................................Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Buildin YP g ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . .._.... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Ga; Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------_-_-- Diameter...._............... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -- - f ----------------------------------------------------------- ODescription of Soil.._. �?' !L..9 --•---------•------•----------------•---------------•----------•-------••----------------•---------•-•-•--•----•-------- cxj ----------------------- ..............i-.....---------------------- --- -----•------ - W . ... - - ------ - --- --- ------- U Natu of R alrsZ erations—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 issued b the oar o health. Signed A . ----....• d ............ �1 Date ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following 'reasons:............................................................................................................... -•.....-------••---•-----------------------•-••------••••••------•••-----•-••-•------•-----.....----............•••-----------•------•••---•••------••----•------•--•••••-•---•-••----••-•--•••------••. Date PermitNo......................................................... Issued _ . D J- _ ... No.. .. -_...t r v11 X7° '� Fic$.....I S...p THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH >h ...........................................OF,............................................. ApplirFatiun for Disposal Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair '( ) an Individual Sewage Disposal ` System at: :,�! .. .... s � L4c t A •r s or Lot No. N a .e ...A caner.......... (.. {� ............... . .....�.. .. Installer -• U Type of Build' Address Size Lot............................Sq. feet Dwelling PNo. of Bedrooms.,......................................Expansion Attic ( ) Garbage Grinder ( ) WOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow:....................................•...•__gallons per person per day., Total daily.flow..._........................................gallons. W Septic Tank. Liquid capacity............gallons Length................ Width........:........ Diameter-_._____-_.---_- Depth................ x Disposal Trench—No:...........:.:...... Width.................... Total nth................... Total.leaching area--- _----------.-----sq. ft. �: Seepage Pit No________________•.--- Diameter.................... Depth below inlet................._.. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank'( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2......:.........minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------ Description of Soi..._-_ 7f" W .............................. Nat e of R airs(� } terations—Answer when applicable_... 1 4 D _ -------•••-----•-•-------------•------------------•----------•---------- - 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 issued th ealth. -- �� J4................ Signed .7- ..- Date Application Approved By:...............................: Date Application Disapproved for the following reasons------------- .................................................................................................... ...---•-------------------•-.............................................................................---------------------------------------------------------------------......................... D ate /.1 Permit No. IssuedZ P.` �0 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................a..O F..................................................................................... (Irdifiratr of TompliFanrr THIS IS TO CERTIFY, T t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------------------------------06 ------------- .........-----•--••••-•-•••----•-----•----------•-•.............---............................................._----:._... 7 Instfirer has been installed in accordance with the provisions of TIT I F 5 0�Th�State Sanitary Code as described'in the application for Disposal Works Construction Permit No.___... j �..... ............. dated_-....____.__.___....____._.....__......... '. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC' TORY. DATE.......................... ..�::.. -----•----.. Inspector._J.� ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF 1 ...................................... ..............---...................-_........._.......•---.......................... NO.. FEE..-/............... Disposal arks QV.1 nrt!�1/1_ rrmi Permission is hereby granted............2Z.......... � ........0.:_• ...................................•.... to Construct ( ) or�Repair ) an Individual Sewage Disposal System at No Street — y as shown on the application for Disposal Works Construction Permit No..................... .Dated:.,.....4.......................4....... �� Board of'Health DATE........................... -.. - -fig ----• ..t... FORM 1255 A. M. SULKIN, INC.,'BOSTON