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Home My WebLink About0299 SEA VIEW AVENUE - Health , U ,� o w u �__ „A .- .� io+ ° '• W ° � ." ^Aa,P`�g � :P� u � �� z��°� *"°`� sw a. > R ,.. _ ° _ d�• - �" �, ..,, �• , � ��.� "q < �.. ,.a ° ,� a ��° rt��r a w° "°° ' �r ° _ r , .. ., > •, � n ° '° > .fir ''a 4� a'' a I ° n ° , ^ .a ap�yG g O, � � •. a ., u- x ° , ° ° a w ^ ° s „ 0 R w ^ q .y� v 0 . . . ti° o < y q P a^ " 6 YS- ° n , e i s ° U n ° > ° ° ° No. 2 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _4L Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migool 60!9tem Con0truction Permit Application for a Permit to Construct( . )Repair(>Q Upgrade( )Abandon( ) O Complete System Individual Components Location Address or Lot No. a9 q S e AV(e,lit.° A VC_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel O S"re-(-t/1 i 40. ( ' ,r- n Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gor4rn (�Ofvs of C0rd_ '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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S. Description of Soil, ° Nature of Repairs or Alterations(Answer when applicable) 24y, ("L 17A i� 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 Tit 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by Bo of Health. Signed Date Application Approved by r'L✓- Date 3 c Application Disapproved fo the following reasons Permit No.)-W&-- 1'2 3 Date Issued lDelk A. Ci No. )0o k— 1 2 3 Fee Ido "c U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. <<.� • ter., Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE} MASSACHUSETTS 3ppr(cation for Mi.5pool *p!5tem Con.5truction permit Application for a Permit to Construct( )Repair()4)Upgrade( )Abandon( )_ O Complete System Individual Components Location Address or Lot No. RCI R S P.AV I C J A uC. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0��f V t �-' 3 �a( rA n e,I—Z ; Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t GO(4rn Type of Building: L t Dwelling No.of Bedrooms G T Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( )%Cafeteria( ) Other-Fixtures DesignFlow.._ ;r" gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title C 1 Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs: Box t"c .or Alterations(Answer when applicable) pA l r _Date last inspected:Agreement: ,x: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Titl 5 of the Environmental Code and not to place.the system inyoperation until a Certifi- y: I Cate of Compliance has been issued by i Boof Health. Signed i— .` ' Date Application Approved by. _ 4I, Date 3 a2,tr'lb Application Disapproved fo the following reasons Permit No.)L O)tr 1 a Date Issued- 7/DJ &or . x, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( .)Upgraded( ). Abandoned( )by \J M oS at a�O1c'1 Se. 0 w AU�> �S fvrl has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.D00i= I.1 dated 2,.2 —o Installer Designer The issuance e 't sh 1 not be construed as a uarantee that the s s ton7lu/ nction'as des2 ned. Date g Inspector y v g�I �— p ks l_ Fee /THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS RR6X Ce� MiZposW &pZtemc Construction permit Permission is hereby granted to Construct( )Repair,)Upgrade( )Abandon( ) System located at a R C� Sera V I P. V L a.ST f U, 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:Constr juctio must be completed within three years of the date of this p rmit. Date: 3 I a t� �� Approved by THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�'J LI DATA '' Q TOWN OF BARNSTABLE .'L CATION a 1q SeAycw Avt SEWAGE# VILLAGE DGrv,lk ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY c1-y1�1� LEACHING FACILITY:(type) - (o,Y,C UW (size) 3 STOnk N0. OF BEDROOMS C0 OWNER �rAn e'rz PERMIT DATE: 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 FOr� Yl !OIOF Froxr Door Q 6Arg9` U Tal I i 3 3S� a 4JI SS y 3 3 V) COMMONWEALTH OF MASSACHUSETTS *N11 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM,FORM PART A CERTIFICATION Property Address: 299 Seaview Avenue Osterville, MA 02655 - Owner's Name: Abraham Dranetz Owner's Address: Date of Inspection: April 10 2008 Name of Inspector: (Please Print) James M. Ford Company Name: James.M. Ford Mailing Address: P.O.Box 49 Osterville MA 02655-0049 . Telephone Number: (508)862-9400 ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the in ormation rreported below is true,accurate and complete as of the time of the inspection. The inspection was performed based` my�-: :k training and experience in the proper function and maintenance of on site sewage disposal syste , I am OEP cw- approved system inspector pursuant to S M ection 15.340 of Title 5(310 CR 15.000). The sy(tem: ✓ Passes Conditionally Passes co Needs Further Evaluation by the Local Approving Au orityrn F is Inspector's Signature: Date! April 12,2008 , The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or PEP)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 DER The original should be sent to the system owner and copies sent to the buyer,if applicable,.and the approving authority. Notes and Comments ****This report only describes conditions afthe 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 page I Page 2 of, 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 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: 2 i Page 3 of, 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 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 I 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Draneti Date of Inspection: April 10, 2008 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z 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. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. . ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 System: 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. 4 r Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 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 nonnal 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 infonnation 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 ✓ _ 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)]. 5 r Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz: Date of Inspection: April 10, 2008 . FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 6+ Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Summer use 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 Source of infonnation: Unknown Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons'--How was quantity pumped detennined? . 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 a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: installed on 313183-per as-built Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron._40 PVC _other(explain): Distance from private water supply well or suction line: Commnents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) i Depth below grade: 12" 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: 2000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" r Distance from top of scum to top of outlet tee or baffle: . 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measurin_Q stick Comments(on pumping recormnendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were vresent. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage Tank is in the driveway and appears to have a heavy top present. GREASE TRAP: None (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.): 7 f Page 8 of 1'1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 TIGHT or HOLDING TANK: None (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: Corn ments(condition of alarm and float switches,etc.): i DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was in the driveway. A new H-20 D-Box was installed with steel cover to grade Permit#2008-123 PUMP CHAMBER: None (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.): 8 . Page 9 of I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: . Type ✓ leaching pits,number: 2-6'x6' 1000 gal with 3'stone per plans. 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.): The leach Pits were dry. There did not appear to be any signs of failure. A camera was used for the inspection CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth:top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Commnents (note condition of soil,.signs of hydraulic failure, level of ponding,condition of vegetation,etc,): PRIVY: None (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.): 9 Page 10 of'11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued). Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: Apri1.10, 2008 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. FronT 'Door a 6grq'� Q �I a 1 i3 3Sc aAll SS y y1E 10 r. Page 11 of'I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 299 Seaview Avenue Osterville, MA Owner's Name: Abraham Dranetz Date of Inspection: April 10, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water, 14'+/. feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Usiniz Barnstable topop_i:aphic and water contours snaps, the maps were showing approximately 14'+1-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 y�PTown of rnst,-.ible ( - Regulatory Services " M anxtvsremE, Thomas F. Geiler, Director �ArfvMa�a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-7 -90 6304 r REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit'. If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIaDisclaimer Private Septic Inspections.DOC AT ION SEWAGE PERMIT ' NO. 41LLAGE I N S T LLER'S MIE i ADDRESS 11 U IL DE R OR OWNER G DATE PERMIT ISSUED r DATE COMPLIANCE ISSUED3d 3 - y 1 per R c H i { i jell No c . - _ Fx$.. ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G. ...........OF... � � ------------------------------------ �d Appliratiun for Uhipuual Works Toustrurtiun ramit Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individu wage Disposal System�y•,.-�1/. p �/��w��nIe��r!y�6� U...`.../.!..___.-.-.•---------••°-�•-l-.-`•-:•`•••--g--•oViz_ r..._ ..... .......................................- M/P � ato rt No _ ` ..- ...l..`..3....�....�... . .. -e ..._..---^----__...... Address � Installer Address /` U Type of Building Size Lot._____f______________ __ Dwelling—No. of Bedrooms.__..__............................Expansion Attic ( ) Garbage Grinder 74e95 p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures d >----------------------------------------------------------------------------------------- ----------- -------------------•---- W Design Flow....................ug�— per person pFr day. Total daa'ly flow............................................�_________..g4llon�., WSeptic Tank—Liquid'capacity-�?�gallons Length_�j_"'0L'' Width_4_ /!_.__ Diameter________________ Depth__Q__'.1-L..... x Disposal Trench—No_.................... Width_____.------------ Total Length.......... 7... Total leaching area....................sq. ft. Seepage Pit No......9.......... Diameter.....Z&_t------- Depth below inlet___...__..4....... Total leaching area_6. .....sq. ft. Z Other Distribution box ( Dosing ink 6 �� ..� Percolation Test Result Performed by-------------- __- ._ ............__ Date____.._._............................... ------------ - Test Pit No. i________________minutes per inch Depth of Te Pit__._ ,._..___ Depth to ground water_D .....� Test Pit No. 2................minutes per inch Depth of Test Pit..... ____ Depth to ground water........................ Description of Soil----- ��---------------- ................ I------ 2 ..-- /...°. .................................... . - U ------------------- •--•------------------------------------------ .------- ------ •-------------------------------------------------------------------------------- --------•-•--•-•--------------- W --------------------------------------------- --------------------------------•-----------------------------_......_._....------...-----------------------------------------------..._..__••••- VNature of Repairs or Alterations—Answer when applicable................................................................................................ •----------------------------------------------------------------------------------•---•---•--•---------•-•--•---••-•---••-•-_.._..-•-••--•••-••••••••••-••---•-•-•-•---•-----•---•----.........__-•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIE 5 of the State Sanitah,_ — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ueV th.Si ned-- •-••• ViaApplication Approved�.By- - 04----"'--,1 ------- ...----�� ... Application Disapproved for the following reasons-----------------------------------------------------•---------•----------------•----------------------•-•--_..._ -•••--•--••••-•-•••-•--••.....•-•••-•••-•••-•---••-••---••-•••-•-••-•••••--•---••.............••••--••--•-----•-••---•-•-----••-••••--•-•-•••---•-••---•----•-•••--••-••-•••---••••. ......... Date PermitNo......................................................... Issued-----•-------------- ................................. Date No... - 5�� F�s..��S ............... THE COMMONWEALTH OF MASSACHUSETTS V_ BOARD OF HEALTH �j 41) Applirtt#ion for Uispoiiai Works Towitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: . .............• olio -Address o Lot No. - .. l..r -•-•--.../ lr►.�. ....................... r . ..........................................t ......................... Address a ..................at-----. .......................................... .......---------•---••-•-. Installer Address / Q Type of Building Size Lot...__.1.....Jam. _.... ." t Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (` (�j a`4 Other—T e of Building -_---- No. of persons............................ Showers Other—Type g ----------•-------- P ( ) — Cafeteria ( ) Q Other fixtures— per person per day. Total d�ily flow..............._ .. _ _..__.____.g�llon ., W ;1(-K Septic Tank—Liquid capacity. gallons Length-//_./L."' Width_e..-6 . Diameter---------------- Depth_ :.-..... x Disposal Trench—No.......... ......... Width...... ............ Total Length............... Total leaching area._.(_...............sq. ft. Seepage Pit No______ _____________ Diameter...__Lc......... Depth below inlet......._........ Total leaching area. .: .....sq. ft. Z Other Distribution box ( Dosing tank �� 13: `�'— '4 Percolation Test Result Performed by................ .................V...._.._�.._........ Date_.................... ... 14 Test Pit No. 1... ..._._minutes per inch Depth of Te Pit... oZ......... Depth to ground water.ClJ-____-__-_.-.z-4 f=, Test Pit No. 2................minutes per inch Depth of Test Pit..... dam........ Depth to ground water........._...__....._.`.. Description of Soil----. ) ... ................... .....: :. �'1 .------ �-/ i -2.------. - --....... � � V .....------•--••----•••----•-•---•----------------------------•......•--•-•-------------- ••---------...-•----------------•---• .. W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------•----------........---------------------------------------...---------............----•-------------------------------------.._...----------------•--------•-••--------._.........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL%, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be is ue the boa health. Signed Dat Application Approved By. ._.. ._.....-�,�'' ��'-•-•--•----•--------- ..-•--• ate Application Disapproved for the following reasons:................................................................................................................ .......................•--•--•---••-•---......--•------------.......---------........---•----•----------- Date PermitNo......................................................... Issued_........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...........................................I......................................... �r��f�rtt#r ,af f�unt�r�ittnrr THIS IS TO CERTIFY,,That the Igividual Sewage Disposal System constructed ( ) or Repaired ( ) by ---•-- --------- •-------------- --------------------------------•------ ...._...--------...... ------------ at.............. "...... ----- ------....:.I ......5'!V`o�".........--•----=_sta_ Ile -------------------------- has been installed in accordance with the provisions of TIT F 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__ $y L'............. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM Wo UNCTION SATISFACTORY. DATE •-. __e? _......... :.: Inspector.. --- ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................... ...................................................... No.. .21_ $ L- FEE..3r ....... Rapostt1 �k �ttn Uan �ernt�f Permissionis.hereby granted................ ......�aa�e.L�.�.............•----•---------------•-----------•--•-------........--••-----•-•. to Construct ( or Repair ) an Individual Sewage Disposal System atNo........�-rI--�?----••---- -------- -" �"' ...................................... Street as shown on/theaplication f isposal Works Construction t No...................... Dated.. ......__._..._...._. --------------••----•-•-------•DATE.--� .............. - r of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS \ di f C � i LO CAT ION SEWAGE PERMIT 110. VILLAGE G ��- IMST LLER'S III 6 ADDItESS 8 UILDE R OR OWNER DATE PERMIT ISSUED _ �T ��_ �� DATE COMPIIAMCE ISSUED d ` r 1 rr,,z . r