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HomeMy WebLinkAbout0183 OST.-W.BARN. RD - Health 183 OST1! WJ BARNIF _-,g R QQ A= OSTERVILLE �4 a 0 i I ,4 , {i �' G;! No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplitation for -Misposal *pstem Construction Permit -' Application fora Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.i$3 404.W,C30.r AS. `%e Owner's Name,Address,and Tel. o.0)nu-V 2 r7- Assessor's Map/Parcel(go.W3-L>= vs I vie rShsyS its Oar Installer's Name,Address,and Tel.No.,51016•V�B=YSga� Designer's Name,Address,and Tel.No. r�l-c� ►t Ig 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 Al ti 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) 14bai 6" + 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 n to place the system in operation until a Certificate of Compliance has been issued by this Board Signed Zn Date 1,7e> Application Approved by Date Application Disapproved by Date for the following reasons Permit No. qo 0— 19-If Date Issued /-�Y r No. d 0 �y r 1, Fee - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplitation for Misposal *pstem Construction Permit ' Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components -n Location Address or Lot No.183 04.L0,f3k(i\S66i,_ Owner's Name,Address,and Tel.No.✓jnq 4/9 f7-(,I)OS �u Assessor's Ma /Parcel P -ac,3-LXi ,r rc u Installer's Name,Address,and Tel:No. h Designer's Name,Address,and Tel.No. ( ��totEi C�.��s c�-iu�;,,�c y5�"► �sh'yR A) A Aat):c irWtAl,f a, OA ulug 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 A gPd Plan Date Number of sheets Revision"Date Title Size of Septic Tank yJ Type of S.A.S. Description of Soil J Nature of Repairs or Alterations(Answer when applicable) ,�/� /Jl 1 0 4 13,o.­ :, (��rirr C 4 ` 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. ! y Signed Date t Z") tt Application Approved by _ , Date L/ - .-/ Application Disapproved by Date for the following reasons Permit No. a 0 7-U^ Date Issued 4 Y ' 2c) --------------------------------------------------- - - - - - - - - THE COMMONWEALTH OF MASSACHUSETTS ( � 1/ BARNSTABLE MASSACHUSETTS - >4 Certificate of Compliance THIS/IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned,(/)by at 883 vQS{,tr e Q ��e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 o�10' l)q dated L' - 7' Z Installer Designer #bedrooms Approved desi ow fiv f gpd The issuance of thl permit shall not be construed as a guarantee that the system will ctio as designe& Date If 0 Inspector !! ------------------------------------------------------------------------------- ------------------------------- - ------------- No. f) " Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at ` 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:Construction must be completed within three years of the date of this permit. Date Approved by ( t TOWN OF BARNSTABLE TLATION /'B 3 0 411,/. ZEWPA1- /6- SEWAGE # VILLAGE ASSESSOR'S MAP & LOT r7Z/—003 INSTALLER'S NAME&PHONE NO. ell 7-O 41;r SEPTIC TANK CAPACITY 1,5"190 LEACHING FACILITY: (type) �00(��l���,5t /-E/(size) 9s X 1 j NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE:T 9Z F 9 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 fi`ci�lity)) Feet Furnished by i Front 3'. . 3 1 i `Z �' �` ��4-4OWN OF BARNSTABLE LOCATION SEWAGE #' l /_2 O VILLAGED��i P� ASSES ORBS MAP&LOT oo a • 601 ngsalmm NAME&PHONE NO. . SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) GG IS C �� (size) NO.OF BEDROOMS BUILDERO _ C(UiCJ ��o2ta PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) �� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac ng acili IV4 Feet Furnished by �za V ( 3 p t9 a ya Ov�� FC.ow -���N 1�t3c� ��t t`t�'✓v��n�YV� L0k", r-TIDN SEWAGE PERDMIT N4. I_ LA6E I S T A L 'ER'S NAIVE A ADDRESS OR OWN FER DATE PERMIT ISSUED DATE C 0 M P L I A N C E ISSIII, D a - -T /� �� �7 � � 10 _ � , � f � � � � I FX1S1lr1f� {"(tTCHF1`j i AkiCD OPGO'NcGc IINC- — - i L Ii Zi. ' 1 -- - z° IA-1 J h . Ro j �_ r , w�°\gams p2601 ���� ' + �POgox534 r���S � . � � F `ne l5pa)�9� ; A i i , No. �r !�� '. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppficatiou for Oigooar gten� �tConotruction Permit Application for a Permit to Construct( )Repair( )Upgrade(' )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./,?— 05r. Owner's Name,Address and Tel.No. ©Sr;���i%I� �` Joyce CH-C.sGi Assessor's Map/Parcel - 0 0—5 OG�Z 8 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Tiiie Size of Septic Tank Type of S.A.S. Description of Soil Rio Ni� Nature of Repairs or Alterations(Answer when applicable) f e!f L6 c/Z /:go sT Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this 13oard of ealth. Signed Date 7-/9-?y Application Approved by Date 7 Application Disapproved for the following reasons Permit No. 9 ` Z® Date Issued 7— — No. ` : b d' 1 Fee ��o '.......►� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN:-OF BARNSTABLE., MASSACHUSETTS 2pprication for Migozar 6 stem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System 1:1 Individual Components Location Address or Lot No./,v 0Y r W/64,0w. 4.1 Owner's Name,Address and Tel.No. 40' Assessor's Map/Parcel �`Sl�'/'✓�//� JOyG/_� G!�a (.j z Installer's Name,Address,and Tel.No. L/ 0?41 9 Designer's Name,Address and Tel.No. . �ctSc,�ti ,� (�i9rNOs ✓cue��i d-a/,�irer.•-�„S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons.• Plan Date Number of sheets Revision Date )Title ' Size of Septic Tank Type of S.A.S. Description of Soil \ Nature of Repairs or Alterations(Answer when applicable) 2�.�s4, ris& /4'4249 l.�.rr� 2 6'00 6A, . A-V i.�// �i r ti �,so ,r tgrdu�•f/' I�,D. ss ra�,r Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. F Signed Date Application.-Approved by 8. - Date 7—/9-9 9 Application Disapproved for the following reasons ,y Permit No. q Z f> Date Issued 7- -- - ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(4..4•Repaired( )Upgraded( ) Abandoned( )by '10,(e 91. at /83 .es-� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. T\ dated Installer Je< 0. ,n. i..-..Y,c Designer - ` , The issuance of-thi4ermit shall of be construed as a guarantee that the syste, v�'.lL ulnction� as�rdes gxted.� v �� C Date ` � ��, Inspector l��% YR �Ii�� � v#6rr v q No. � � Z O —�°---rt----------���GD$-----Fee �.''�" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'Wi5po5al *pgtem Construction Vermit Permission is hereby granted to Construct( epair( )Upgrade�a2 bandon( ) System located at 191r f !.� (� 11-e 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. Provided:Constructio must be completed within.three years of the datZZO I. Date: 7/�// y 7 Approved / •�'"-' . vim, ,o 1/6/99 NOTICE: This Farm Is T® Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L ; o f ,- ,ras-.-'�5 hereby certify that the application for disposal works construction permit signed by me dated �7 concerning the property located at /?I eV ,,. /Gr/���r.�, �� (�st /l�neets all of the following criteria: The failed system is.connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. 6---The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. /----There are no wetlands within 100 feet of the proposed septic system A There are no private wells within 150 feet of the proposed septic system k—There is no increase in flow and/or change in use proposed &--There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma.�dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation 5+the MAX. EIigh G.W. Adjustment D117FERENCE BETWEEN A and B SIGNED : DATE: (Sketch proposed plan of system on back]. q:health folder.cert a', o"Y' l.�/ralS i i-�} �c�� �r�., a",r ��u�^,� � '... s a MNO � r^ 'ter "y � "'�'y t t "�^- to s :a� � ��x 'k' <.o- TOWN OF BARNSTABLE v, LOCATION_L[S 3 4 r� S SEWAGE # T A L VII.LAGE. Pr Hyi ASSESSOR'S.MAP d�'IOT1Z2/ ao 3r F INSTALI:ER'S NAME&PHONE NO7� SEPTIC TANK CAPACITY __ t SOU LEACHING FACILITY: (type) 5' r (size) X 13 NO.OF BEDROOMS_ , BUILDER OR OWNER PE'RMTT DATE:T 71 I COMPLIANCE DATE. . ;.. io Se arat p...- -. n Distance Between-the:- z4 f r Maximum Adjusted Groundwater Table to the Botiom of'Leachmg Facility Feet 'isi o r ,r F Pnvate Water Supply Well and Leaching Facility (If any wells exist 7 � ki�kP it ` ' 3 on site or w'tthln 200 feet'of leactung:facility). 3 Feet Edged Wetland and:Leaching Facility(If any wetlands exist , i within 300 feet of:leaching f ili R Feet Furnished by r } 9 N_ :.. 1 r y x 3f zs t a no tf _ i s i ,t} � t .{�z Wi a nc iz of-''c'y i ` '� $- 4 ����� _�"Y` 4° t i'x..�..*KK°`yr `Via. .e•zr � ' ,s�}`�'�✓:�:*'� �� � � e �s9�• •f a r- � r� ;� r ..�-..�:.. :,.......,u v'F.N.' -...T wy, F:.. CYr nw..s:._„.,.. L . ..�.aa-"o'i �.. ��_.,. .. ti. �- M ..,,d�.,:.._..--• ..�:"� ,a;M x� i�r -e ,M i,� Lcr w `�-�.• � y r` i �.� 4� :s:'3.t , �.,�,� r2 �� -� y->m. _ -,, •c.. r ' oZ 66 4 *t yF BORTOLOTTI CONSTRUCTION,INC. 19 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 �g 96 508-771-9399 508-428-8926 FAX:.508-428-9399 10, � Q Aj :ram SUBSURFACE SEWAGE DISPOSAL SYSTEM.•INSPECTION FORMi V PART A 109 C; Ds _ CERTIFICATION Property Address: Date of Inspection: - - (o ±1tor's Name:Oer's Name and Address: G I d CERTIFICATION TAT MENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training"and experience in the proper function and maintenance of on-site sewage, disposal ems. The System:. Passes Conditionally Passes Needi Furtherqvaluation By the Local Aproving Authority 'Fails Inspector's`Signature: Date: y�7l y(e' The System Inspector shall sub t.a copy of this inspection report to the Approving authority.within.thir ty(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 Department of Environmental Protection. '['he original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. PP g. I INSPECTION TM ARY• A),SYST PASSES:, I have.not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. s r, B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon'comple- :tion of the replacement or repair;passes inspection. - Indicate yes;nor;or not determined(Y,N,OR ND), Describe basis of determination in all instances. If "not determined",explain why not. t The,septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is inuninenl. The system will pass inspection if the existing sep- ,',,tic tank is replaced with a conforming septic tank as approved by The'Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed . Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system wiffpass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed 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 the public health, safety and the environment. 1)SYSTEM;WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM,IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNEWTHAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE; ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to.a'surfacel water supply or tributary to a surface water supply. `. The system has a septic tank and soil absorption system and is with a Zone I of a public water supplywell. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50` Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution froin the facility,and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm• D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. 'The Board of Health' ` should be contacted to.determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool Discharge or ponding of efluent 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 clog- god SAS or cesspool. Liquid depth in cesspool is less than G"below invert or available volume is less than 1/2 day.flow. Required pumping more than 4 times in the last year Nfil due to clogged or obstructed pipe(s). +Number of times pumped -2- SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is withiu 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: 5 The following'criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more:of.the following: conditions exist: 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 Il of a public water supply well The.owneror operator of any such system sliall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.60 and 6.00.:Please consult>the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following.have been done: ~ r Jk-"Pumping information was requested of the owner,occupant,and Board of Health. v None of the system components have been pumped for atleast two weeks and the system has w been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As-built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. : _✓All system components,excluding the Soil Absorption System, have been located on site. !",The septic:tank manholes were'uncovered,opened,and the interior of the septic,tank.was in_,s — spected fouptidition of baffles or tees,material of construction,dimensions,,depth of liquid, depth of sludge,depth of scum. _ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) The facility owner(and occupants,if different front owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION FLOW CONDITIONS RESIDENTIAL: Design Flow: gallons Number of Bedrooms: Number of Current Residents: Garbage Grinder:_ Laundry Connected To System:_)4!�aS Seasonal Use: Water Meter Readings, if Wilable: Last Date of Occupancy: C_/PA11)e" COMMERCLAI./INDIJSTRIM /VV Type of Establishment: Designflo;*' ' " ''`i gallonslday1YGrease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of infonnati n:�/ (�/1�/Ty�/ System Pumped as part of inspection: if yes,volume pumped. gallons Reason for pumping: TYPE OF'SYSTEM: Septic'Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy hared System(If yes,attach previous inspection re ords, if any) Other(explain): �3 D Gz2e (�C ��(' S' APP OXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: 0 -4- • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade:, Material of Construction: concrete riietal FRP Other = ' (explain) — DI -dsions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or-baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc:) GREASE TRAP: ..AlD Depth Below Grade: Material of Construction: concrete metal FRP Other r (explain); — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) TIGHT OR HOLDING TANK• Depth Below Grade: - Material of Construction:—concrete_metal_FRP Other(explain) Dimensions: Capacity: gallons Design Flow: gallonstday Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) t . DISTRIBUTION BOX:14 Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER:_Z�/z Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: 'Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches, number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Z Comments: (note condition of soil, signs of hydraulic failure gvel of ponding,condition of vegetation, etc.)2 i5 cZ. Ca 'D x ��'LJ (�s"s'S� o/. /YId,21Y A)1,66 c� CESSPOOLS: Number and_configuration f= ;t-5�' Depth-top of liquid-to inlet invert: Depth of solids layer: "° Depth of scum layer: Dimensions of Cesspool: 'fie '?�Y 5' Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failyl level of ponding,condition of vegetation, etc.}-1 S Kell t! led r a d s villr PRIVY: j Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) Y i -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benclunarks: Locate all wells within 100 Feet.' 9 w DU b DEPTH TO GROUNDWATER: Depth to groundwater: /: 9 . Feet �s Meths of Determination or App}oximati n: 41`- �✓Il�/1 i -7- - o TOWN OF BARNSTAB`LE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. I PARCEL NO. T ADDRESS OF TANK: i ./ 11 i Cl • I&I LLAGE: _; QA ,a Number ®trmmt MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: C i�(7 I � r1- i C� '✓'t s PHONE: I"!STALLER ADDRESS: CERT.NO. *TANK LOCATION: _ It '� /fi✓ d-c.Go '� _ . ".. �dr�-c commCR I•i TANK L-OCAT I ON WITH RNSF-GCT TO wu I LD I Nm CAPACITY ? TYPE OF TANK '-6X 0 ( k AGE - I) YRS. FUEL/CHEMICAL 6))` TESTING CERTIFICATION [t/J PASS [ J FAIL DATE LEAK DETECTION [ J CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [A YES C J NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C J YES C J NO DATE CONSERVATION [ 'f�CHECK IF N/A DATE f BOARD OF HEALTH TAG NO. [ ] DATE %r✓ ll * PLEASE. PROVID.E 'A SKETCH SHOWING THE TANK LOCATION- ON THE BACK OF THIS CARD ,r OSTERVILLE - Sunny home, pic- ture perfect condition. 8 rooms, new Florida room, can't be dupli- cated at this new lot price of $145,900.