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HomeMy WebLinkAbout0037 BRIAR PATCH ROAD - Health (2) 37 Briar Patch.,Road Osterville P `s " A = 143 037 ek a » y ° a d o c e a eq is , a , , . m , a , r " ° • .w a . ^ e ° S i , , , e a^ ^ e'er d' a n Y,p- ^ J , c b p, : a a h e u•. � m, 4 o ° a 8/18/2021 37_Briar Patch_Powder_Room Sketch_Sun Jun_20_2021 23-37-17.png(1164X966) OFFICE 20'0"x 15.16" BEDROOM 11*11"x 15'0 e BAT 4'8" 7'4" BEDROOM 1313"x 15"11" BONUS ROOM HALL 15'1"x 12'11" .. 1219"x.5;1„ 'v OPEN TO BELOW GAOSS 61MAX4 ARQA FLOOR v 024 w A.FLOOR 2:2327 to.m .. - .. FLOOR 9:1195%4,A,MAUDEO AREAS; .Nauset.Media - OECD;43 TOT�AR.OAW:4B 3T6 soft - - - rGa:soar sR,a - - aES.[f6r.115$M'A4`L3t2!s;A►[eFP41;.rf;�,ai1,kLYJALMtp{'l3Si https://vpc3uploadedfiles.blob.core.windows.net/vpc3-files/barnstablema/37_Briar_Patch_Powder Room_Sketch_Sun_Jun_20_2021_23-37-17.png?s... 1/1. 8/1812021 .. O. 10 r �•. t . y https://townofbarnstable.us/propertyimages/00/22/72/12.jpg 8/18/2021 photo_(33)_Tue_Aug_17_2021_10-37-28.jpeg(512X384) IL 'if ra_ �? } Mlfml'I,ti8i M S8>OL.LC WN. @Se iQs Q£4+9;7�s S - Nauset Media https://vpc3uploadedfiles.blob.core.windows.net/vpc3-files/barnstablema/photo_(33)_Tue_Aug_17_2021_10-37-28.jpeg?st=2021-08-18T12%3A25%3... 1/1 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every page. Citylrown 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 bid d(the form. Important:When filling out A. General Information forms on the computer,use 1. .Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name ; P.O. BOX 145 Company Address CENTERVILLE MA 02632 'eA0l1 City(rown State Zip Code 508-420-4534 S14297 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 t�o�Section 15.340 of Title 5(310 CMR 15.000).The system: ® -Passes ❑ Conditionally Passes ❑ Fai`ls �.,�..�-� . •�= ❑ Needs Further Evaluation by the Local Approving Authority . Z ' to S l 8-22-14 Inspector's gignatu.re 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. ell l5ins•3P13" .`" Title 5 Official Inspection o bsurface Sewage Disposal System•Page 1 of 17 r: , Commonwealth of Massachusetts Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form --Not for Voluntary Assessments ,M 37 BRIAR PATCH RD Property Address FACEY Owner Owners Name information is required for OSTERVILLE MA '8-22-14, - every page. Cityrrown 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: SYSTEM WAS PUMPED AND A NEW D-BOX WAS INSTALLED AT TIME OF INSPECTION 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): r _ 7 W t5ins•3/13 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 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 ' every 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.): r ❑ 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 o'r obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y tl ❑ 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 BRIAR PATCH RD' Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA a 8-22-14 every page. Cityfrown 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: 0 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: t D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Z Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Z 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 '/z day flow t5ins:3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is 8-22-14 required for OSTERVILLE MA I every 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 groundwater 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. ❑ N 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. ❑ Z The system fails. I have determined that one or more of the above failure criteria exist as described in 31.0 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"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 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts..'' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRIAR PATCH RD- Property Address FACEY Owner Owner's Name information is 8-22-14 required for OSTERVILLE MA " every page. CitylTown 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 t .- ® •.❑ 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? Have'large volumes of water been introduced.to the system recently or as part of this inspection? °® EI 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, locate6on 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? z 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 r - El ® approximation of distance is unacceptable),[310 CMR 15:302(5)] _ D. System Information r . 4 , Residential ,Flow Conditions: -Number of bedrooms(design): 3 (Number of bedrooms (actual): 3 330 DESIGN flow based on 310 CMR+15.203 (forrexample: 110 gpd x#of bedrooms): t5ins•3h3 - I �• - 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 GSM , 37 BRIAR PATCH RD - Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: SEE ATTACHED AS-BUILT Number of current residents: 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 Seasonal use? ❑ Yes ® .No Water meter;readings, if available(last 2 years usage(gpd)): Detail: 2012---331.5 2013-----367.1 GPD Sump pump? ❑ 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 Form: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 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA •8-22-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection?, ® Yes ❑ No If yes, volume pumped: . gallons 1000 00 How was quantity pumped determined? TANK TRUCK Reason for pumping: MAINTENANCE Type of System: ® ; Septic tank, distribution box, soil absorption system ❑ Single cesspool - ❑ Overflow cesspool ❑ Privy El Shared system (yes or rio) (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 Form:Subsurface Sewage Disposal System•Page S of 17 • 1 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14. every 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: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet 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.):' Septic Tank(locate on site plan): Depth below grade: 1.5 rt. feet Material of construction: ® concrete ❑ metal ❑ fiberglass : ❑ polyethylene ❑ other(explain) Ifaank is metal,,list age: _ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions:. 1000 Sludge depth: ' t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts' , 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE ' WA 8-22-14 every page. City/Town 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' 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? 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 WAS IN NEEDOF PUMPING SO IT WAS DONE AT TIME OF INSPECTION BY DEBARROS SEPTIC 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 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 37 BRIAR PATCH RD Property Address _ FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every page. Cityfrown 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): P 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- t Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 37 BRIAR PATCH RD Property Address FACEY Owner Owners Name information is required for OSTERVILLE MA 8-22-14 , every page. Cityrrown 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 off 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 WAS REPLACED DUE TO THE EXISTING ONE BEING BADLY CRACKED AND BROKEN PERMIT WAS PULLED AT BOARD OF HEALTH Pump Chamber(locate on site plan): v 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: NO OBSERVATION PORTS FOUND t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: - ❑ leaching pits number: ` ® leaching chambers number: 6 ❑ 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.): WE WERE UNABLE TO DETERMINE THE LEVEL OF PONDING IN THE S.A.S AT TIME OF INSPECTION BECAUSE THERE WERE NO OBSERVATION PORTS INSTALLED. THERE WERE NO CLEAR SIGNS.OF FAILURE OR SURCHARGE DURING THE INSPECTION 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 M s 37 BRIAR PATCH RD Property Address FACEY Owner Owners Name information is required for OSTERVILLE MA 8-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System. Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of pondind, condition of vegetation, etc.): Privy(locate on site plan): r 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 , Commonwealth of Massachusetts- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` wM 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 ' every page. Cityrrown 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 to 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 below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17 Assessing As-Built Cards Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every 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: . AT LEAST 5 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: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: AUGER HOLE IN LOW PART OF PROPERTY 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 http://www.townofbamstabld.us/Assessing/HMdisplay.asp?mappar=143 037&seq=1 8/22/2014 Assessing As-Built Cards Page 2 of 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 37 BRIAR PATCH RD Property Address FACEY Owner Owner's Name information is required for OSTERVILLE MA 8-22-14 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D.(System Failure Criteria Applicable to All Systems)completed E System Information-Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins-IM Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=14303 7&seq=1 8/22/2014 J _ a Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION r// 4,- SEWAGE t# VILLAGE O S T ASSESSOR'S MAP&LOT 3-O q I�84a1W'R S- 'a ,fed Pr 9'PA�'S NAME&PHONE NO.��� [ �T u C O SEPTIC TANK CAPACrrY S"f &7/e_ /ti 5/PO1 c CIE NG FACILrrY:(type) (size) O.OFBEDROOMS BUILDER OR OWNER L `PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 71 http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=143 037&seq=1 8/22/2014 RCEL COMMONWEALTH OF MASSACHUSETT EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �a d DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED 0,9M SVe /� 350 MAIN STREET ♦&`,, WEST YARMOUTH,MA MAy 13 2004 508-775-2800 , TOWN HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 143 PAR 037 Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner's Name: TYNDALL,ROBERT Owner's Address: 27 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Date of Inspection APRIL 6,2004 Name of Inspector:(please print) JAMES D. SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the infonnation 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector'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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ I have not found any infonnation 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: N/A 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 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 C. Further Evaluation is Required by the Board of Health: N/A 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 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 D. System Failure Criteria applicable to all systems: N/A 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 flows is less than 6"below invert or available volume is less than%day flow ✓ 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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: N/A To be considered a large system the system must service 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 lI 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 is 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. Title 5 Inspection Form 6/15/2000 4 1 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 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? ✓ 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)has been determined based on: Yes No ✓ 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(3)(b)] Title 5 Inspection Form 6/15/2000 5 I� Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 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: 3 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): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): N/A Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A 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 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1996 PERMIT#96-431 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Forth 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 6 Materials of construction: Cast iron _ 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(locate onsite plan): ✓ Depth below grade: 8" 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: 1,000 GALLON PRE CAST Sludge depth: F, Distance from top of sludge to the bottom of outlet tee or baffle: 29" Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL.OUTLET TEE.TANK AND COVERS 8"BELOW GRADE.NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 ' TIGHT or HOLDING TANK: N/A (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: ✓ (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.,): DISTRIBUTION BOX iIS 16"xl6", l' BELOW GRADE.ONE LINE IN,TWO LINES OUT.BOX IS CLEAN AND SOLID.NO SIGN OF OVERLOADING OR SOLID CARRYOVER. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 SOIL ABSORPTION SYSTEM(SAS): ./ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ./ leaching chambers,number: 6 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.) LEACHING IS SIX FLOWS.THREE FLOWS TO RIGHT OF BOX.THREE FLOWS TO THE LEFT OF BOX. FLOWS ARE 2' BELOW GRADE.4"WATER.NO SIGN OF OVERLOADING OR SOLID CARRYOVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspection)(]ocate 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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 f Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. S y f , I 1 1 , I I i t Title 5 Inspection Form 6/15/2000 10 Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 BRIAR PATCH ROAD OSTERVILLE,MA 02655 Owner: TYNDALL,ROBERT Date of Inspection: APRIL 6,2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 8 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: Observation 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 eater elevation: TEST HOLE 8'NO WATER. TEST HOLE 4'6"BELOW BOTTOM OF FLOWS. -C I Title 5 Inspection Form 6/15/2000 11 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for Oisposal bpstem ConstCUttlon VErmit Application for a Permit to Construct( ) Repair(61/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Addres or Lot No. 3 7?Sr ia✓ h Owner's Name,Address,and Tel.No. Ostefvll1e Assessor's Map/Parcel B -3 ����' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel:No. a `NC 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 Soil Nature of Repairs or Alterations(Answer when applicable) 'Go Lce 'Djslrr i6�-tcA �(y 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. .gn Date Application Approved by Date Application Disapproved b Date for the following reasons Permit No. r Date Issued F No. ". THE COMMONWEALTH OF MASSACHUSETTS'` Entered in computer: . 7 Yes. TDIVISION -T WN O F BARNSTABLE PUBLIC HEALTH O , MASSACHUSETTS ftpYication for Misposal *pstrm Construction Permit 'I Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ;.. Loc tion Addre sP or Lot No. 3 7 l�r ✓ i�a+r h 1� Owner's Name,Address,and Tel.No. S tC I r Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �G� Q i�xa�J 1+vt 506-Y(X)'71 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 Soil Nature of Repairs or Alter (Answer when applicable) �P t��c C 01 5kr i�3V Gox 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. gn d Dated V Application Approved by / Date 4't Application Disapproved by Date for the following reasons r Permit No. I Date Issued THE COMMONWEALTH OF MASSACHUSETTS- ( (jN �� ._. BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired( ✓f Upgraded( ) Abandoned( by Ebu�k s�A 13(/w�N 1 N at 37 13 f i a✓ Be-fC 1 0 VS hfd has been con ructe in:VatPd with the provisions of Title 5 and the for Disposal System Construction Permit N OX . Installer Designer #bedrooms Approved design flow. gpd f V The issuance of this permit shall not be construed as a guarantee that the system w.illftction as cg designed Date �j '/�f Inspector l _— /1► __. _ o. r3 � 13oX ON/ Fee THE COMMONWEALTH OF MASSACHUSETT'Sy PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(✓'r Upgrade( ) Abandon( ) System located at 3 7 B✓►iy '0G f C 4 d 0 .-d idi r 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:Con lon must b co leted within three years of the date of this permit. Date Approved by I A/V 1 y!� far © 3 7 �� No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migonl *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal Sysfem at: Location Address or Lot No ,er's Name,Address and Tel.No. 6t;,I '" Nl-1` h . L,,,,+ (s ib C Y,144 1 4e,0-v i/� w Installer's Name,Add Xs&n�Tel�I W(* Designer's Name,Address and Tel.No. //��ll 44tt ((�3gg�NVV��II 350 Main Street W- Yarmolith. MA OM Type of Building: _ .4 Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building Qom, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 390 gallons. Plan Date Number of sheets V Revision Date V./p Title Description of Soil Dtf 0 f 0t Nature of Repairs or Alterations(Answer when applicable) SLn S f L(l Exp, j3 feet F_7(®t.,75 jj l ,� l S j2ZA, CLj, vnjV 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 a and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o e lth. SigneA.0Date It-,2 7 ' b Application Approved by Application Disapproved for the following reasons Permit No. j Date Issued ...:`No• Fee THE COMMONWEALTH OF MASSACHUSETTS �- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zfppltcatton for ;W9pont *pgtem Conquuction Vermtt Application.is hereby made for a Permit to Construct( )or Repair( w0fln On-site Sewage Disposal System at: Location Address or Lot No ner's Name,Address and Tel.No. J ' !7t i9r C_ 12Z_• p+ (s 46 7yitcQ4 f r Installer's Name,AddresVWel UNCO Designer's Name,Address and Tel.No. } 350 Main Street W. )armo Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building OrS, No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 D gallons. Plan Date Number of sheets 1 Revision Date Alit Title Description of Soil 0-f 0 bin Nature of Repairs or Alterations(Answer when applicable) 1- n S 13 to 3 -(DLJS taj IZA4 0 f uYIlSC ` (d'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 de and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board o e lth. p n Signe Date O -a Z ' 1 C Application Approved by A:�"' d A-1-0- � �- WAlt o Application Disapproved for the following reasons Permit No. 9YL2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certiftrate of Coinphance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( on by Owe for as h s constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -�' dated Use of this.system is conditioned on compliance with the provisions set fo be w: - ---_——_——_ ——___ _=_=___-___�--———- ---- - No. � �` Fee 7C-J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Ot.5pont *potem Congtruction i3ermit Permission is hereby granted to C? to construct( )repair(�n On-site Sewage System located at /;, /` Ilef fC `i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction in IVIM; nithi two years of the date below. s Date: Approved by 0 % SITE P_L A N SHEET / Of 2 SCALE: I 3\ �/2/AR P.4T�'H _ROAD _�90�►'�'AY) c.����------ =— � f s .¢'3 E y"a / I /00 o�A Y N poAjD 8 DQ.O 1 ESMT EL N � o ,LOT /S N 5To. 7' 3F�T/C 7ANK 1 o .v So'14'I3"E . 204 50' 1 !o%U C14A.IAZ'e- OF \ Cf � Wlll IFIA M f, 1