HomeMy WebLinkAbout0780 SEA VIEW AVENUE - Health , 80 Sea View Ave /\l U Q
Osterville
A= 114 - 068
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No. . d`O U7 —t 7>0 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Mig o ar �p5tem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.--?80 Se.AV,(:, / AVC, - Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel sTt.`Vr ILL i U� M C
oo I
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
60rjon RVM u3 _s r-ar�
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(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
Ct,01A tL
Nature of Repairs or Alteraltions(Answer when applica]bl_e, o
) f S T 1 -c 0 )-I% n
14-
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 Boar f h.
Signed Date _
Application Approved by Date 5-1- o IL
Application Disapproved by: Date
for the following reasons
Permit No. 900 l_7 6 Date Issued S' f D"7
No. 007 - 17tfl l j Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplication for Dig 0 oY 6 .5tem Cow6truction Permit
Application for a Permit to Construct O Repair Upgrade O Abandon O ❑ Complete System ❑Individual Components
11�
Location Address or Lot NoI gQ SeAv1Ct&/ /RUC - Owner's Name,Address,and Tel.No.
Assessor's Map/parcel C W '
{
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
L of J0,
�uM vs 3" wry
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(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
w Size of Septic Tank Type of S.A.S.
Description of Soil
rt, A'ZL
Nature of Repairs or Alterations(Answer when applicable) /1 S7 A' -a O 1)'(3O n j
4 /{-a o 14t ivy TQ on teAj-, A%►. 9,# , 6 -Tru- brrue,w,o j ,
Da_te last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
t _ accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of -
i Compliance has been issued by this Boar f H
Signed Date
Application Approved by Date 5--1` o IL
Application Disapproved by: Date
for the following reasons
Permit No. aOy7 - 1-7 6 Date Issued S_ 1-07
aO �-�0� " THE COMMONWEALTH OF MASSACHUSETTS
.r BARNSTABLE, MASSACHUSETTS
�Av lu� on Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constru ct ed�( ) Repaired (✓) Upgraded ( )
Abandoned( )by Q( QA
at -1!&0 SQAU,Liv /RUC d S-rit, *has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ��7 -176 dated
Installer Go,-L &A w /S Fd,r� Designer
#bedrooms , Approved design-flow `, gpd
The issuance of this permit shall not be construed as a guarantee that the system wil+llfunction as desi,gned� V
Date / Inspector _
------- -- /`'----— r-------------�`�------ Z--y✓—---
No. a 00 r - 1 16 Fee 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
,11%i.5pont 6p5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair ( /� Upgrade ( ) Abandon ( )
System located at - Ro S2Avl e, Qc- OS r ,,J+
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit
Date S- ` v-7 Approved by c ��
COMMONWEALTH. OF MASSACHUSETTS
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: 780 Sea View Avenue
Osterville. MA 02655
Owner's Name: Robert&Patricia McCool
Owner's Address:
Date of Inspection: May 1 2007
Name of Inspector: (Please Print) James M. Ford
Company Name: James M. Ford
Mailing Address: P.O.Box 49 i -
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 information reported
below is true,accurate and complete as of the time of the inspection. The inspection was perfoll ed basec�n my
training and experience in the proper function and maintenance of on site sewage disposal systern . . I am-aEP., .
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓. Passesa t "
Conditionally Passes Nerds Further Evaluation by the Local.Approving A hority cii .
..,.F
O
Inspector's Signature: Date: Mav21. 2.00
A.
The system inspector shall subs i a copy of this inspection report to the Approving Authority(Boar of Health or
DEP)within 30 days of completing.this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****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
f conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
v
Page 2 of 11
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1 2007
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.
I
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 detennined",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
Page 3 of 1 I
s
OFFICIAL INSPECTIONv FORM NOT FOR VOLUNTARY ASSE
SSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1 2007
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 CAM 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 aseptic 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 coliforn
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
s
OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 780 Sea View Avenue
Osterville, AM
Owner: Robert&Patricia McCool
Date of Inspection: May 1 2007
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 day flow
Required pumping more than 4 tunes 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 detennined 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 io 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
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1 2007
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)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
f
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May], 2007 .
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 584 gpd
Number of current residents: 2
Does residence have a garbage grinder(yes or no): Yes
Is laundry on a separate sewage system(yes or no): No [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: Currently occupied
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 information: The tank wasp nzped after the inspection for maintenance
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 a copy of the DEP approval.
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
Installed on 11/12186-per as-built card
Were sewage odors detected when arriving at the site(yes or no): No
6
y
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1, 2007
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:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: ✓ (locate on site plan)
Depth below grade: 15"
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: 1500 gal.
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 30
11
Scum thickness: 10"
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: Measuring stick
Continents(on pumping reconunendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.).
Tees were present The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. The tank
was pumped after the inspection for maintenance.
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.):
L
7
Page 8 of 11
l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1, 2007
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):
Alann 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: 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 H-10 and under a driveway. A new H-20 D=box was installed.(see Permit No. 2007-176). A steel cover is to
grade
PUMP CHAMBER: None (locate on site plan)
Pumps in working order(yes.or no)`.
Alarms in working order(yes or no) .
Conunents(note condition of pump chamber,condition of pumps and appurtenances, etc.):
8
y Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 780 Sea View Avenue.
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May 1 2007
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
0
Type
leaching pits,number: 1 -6'x 6"(1000 a� l.)
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 pit had 6"ofliquid on the bottom The scum line was 3'up from the bottom There did not aypear'to be any signs offailure.
Note: The pit was under a driveway. An H-20 heavy top was added(see Permit No. 2007-1076). Steel cover is to grade.
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):
Comments (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:
Commments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
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: 780 Sea View Avenue
Osterville, MA
Owner: Robert&Patricia McCool
Date of Inspection: May], 2007 .
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
A` 'GAro� Proms'
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WA W,41 Q
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10
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 780 Sea View Avenue
Osterville MA
Owner: Robert&Patricia McCool
Date of Inspection: May 12007
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20+1- feet
Please.indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
✓ Checked with local Board of Health-explain: topographic and water contours traps
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high groundwater elevation:
Using Barnstable topographic and water contours maps the traps were showing approximately 20'+/-to Around water 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 4
`r TOWN OF BARNSTABLE
`LOCATION O O SeAVIeW Aue. SEWAGE J#/
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY /SW
LEACHING FACILITY:(type) D,7 �o X (size) I GGd 3 S r0/l!L
NO.OF BEDROOMS
OWNER /OC ca
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 T�S�JC(.'I lUn FOr�
' i wA(ICwp�r _
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3 39
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CouWs 3
TOWN OF BARNSTABLE
k
LOCATION OG 16flQRisa,-✓SEWAGE #
VILLAGE 05 TC-k 4l/ � ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NOA49- �5
SEPTIC TANK CAPACITY / L' T
LEA CHING.FACILITY:(type) /co�G.9�L (size) STotiZ
NO. OF BEDROOMS -� PRIVATE WELL OR UBLIC WATER,
BUILDER OR OWNER k v 4�16 1P- 7- AO w,C-2S
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
�1
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is'oo
` `I 1
_1 ,iSSESSORS MAP NO: _ L/ �.x
No.----... �.... I�O� PARCEL NO.: �j FEs..........-- •---..
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-Led Appliration for Ui ,What lVerkii Tonstrurtinrt rrutit
To
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
SE9 V14--Ul *V&_ �691RWISo.v �/. l��.el/iGGGs Lo7'''Zc>�
................_................................................................................ ....................................................-•--------------------------------------------
Location•Address or Lot No.
......................G �'------�v w�-s------------------------------------------ ..........--.....................................................................................
'e- Owner Address .
a ----••.....-•••- - ----� --------------------------------------------------------- ----------------------------------- .---------------------------------------
Instalier Address
Type of Building Size Lot....`f3_� 11......Sq. feet �
Dwelling—No. of Bedrooms._-________3_____________________________Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria
a' Other fixtures ................................. .
W
Design Flow.............ma's.__._._.__.______._____..gallons per person per day. Total daily flow---___.____-73�.......................gallons.
1:4 Septic Tank—Liquid capacity�S�__gallons Length.8./6 y_____ Diameter________________ Depth_- "8
Disposal Trench—NTo_ .................... Width......._............ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..____-__-.--e�-._.._. Diameter:_... Z'___.__ Depth below inlet...... ______.____ Total leaching area._-t!g.__sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) _
'-' Percolation Test Results Performed b ._f SuGL(V,A - -.- _- !VX --•••• Date.__ �:...��/11&5
a Y r �--------•----•-
a Test Pit No. 1__4 Z_----minutes per inch Depth of Test Pit..... Depth to ground water.... ..............
Li, Test Pit No. 2__L_z.__._minutes per inch Depth of Test Pit_____�3_ u_- Depth to ground water........................
----•----------------------------- ----------------•-•---•--------------•--------------------------------------------------•--•--•------------._
O Description of Soil......... ��=/z` Z0,4 ,1 12 ..-1�y9SA a
- S _ - � ...._.
x
W
x ------------------------------------------------------------------------------------ ........-••-......................................................................................................
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 I I�'i p 5 of the State Sanitary Code—The undersigned,further agrees not to place the system in
operation until a Certificate of Compliance ha beeni s bythe bo rd ealth.
Signe �` ----------------•--•-•-------•----
D to
Application Approved BY- ---------- ----------•-•--•---------- ------ 1 t� -
Application Disapproved for the following reasons------------------•--------------------------------------------•------------------------------------•-•-••-•--•--
•----•--------•----•••---•-----•----••••--•--••---•---•--•-•---•-••-•-•--...----•-•-•--•-----••-••-•------••-••••-•--•-•--•---•-••-•-•••-••-••-•--•-•---••-----•-------------------------•-------------
Permit No.. ----12jQ ----------------- Issued-...........................................
Date------
Date
' tip
y � --
N......... : A_- f 20 F�$.._.._... ........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........
7 ... ...--.....oF....................................... � -----•-------------•--...........--
Appfiratiou for Uhip ottf Works Tonstrurtiott Prrutit
Application is hereby made for a Permit to Construct (f ) or Repair ( ) an Individual Sewage Disposal
System at:
�Cy !//G�ni 4VC' G�J�:1�isv�i ZA1. 1�3.5�;eV1 -GG' 4' 7-Woo 6
..........................•-----•....-•----....--•..._._.....-----------------------•---•--------. ..._._..---•-------------....--------------------.._......------------------------•-••-••-•--•---•
Location-Address or Lot No.
5e;E7- Aa ✓� s
---•••....-•---------------•---•------------------••-•-•---•--•----------------._._........._..-- ---............._______....--------------•-------...-----......_......--------------------•-------
Owner Address
w .. ;26........... ----- ----------------•---..__._......._---____...---------.---..._.._...___._......._._.._.._......--•-
InstaLer Address 43.57
Q Type of Building Size Lot________ ......Sq. feet -4
Dwelling—No. of Bedrooms__________J_____________________________Expansion Attic ( ) Garbage Grinder ( }
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
Q' Other fixtures .----•------------•-----...-•- ----- - --••------.----•---------------•----------------......•-••-•---•-•-----------------•-•----•--...-------_.
W Design Flow-------- :��`--•------ /Sb4---gallons per person per day. Totadaily flow.......... 0---------------------..11l gallons.
g g P P P Y -
� Septic Tank—Liquid capacity____________gallons Length_______________ Width__._:.______.__ Diameter---------------- Depth_ _ ____.
W Disposal Trench—No_ ____________________ Width............ Total Length.................... Total leaching area....................sq. ft.
x
3 Seepage Pit No--------------------- Diameter._..e?�.:.._.._. Depth below inlet..... _...________ Total leaching area_-t�t.4'_____sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.R t&44lV�___ 72.7v,_V.vy6_....... Date... � :.../�_�61v
,aa Test Pit No. 1_4__7n______minutes per inch Depth of Test Pit....!�!....... Depth to ground water___"'_____________
(i Test Pit No. 2'5�_7_____.minutes per inch Depth of Test Pit..... Depth to ground water___'_®'_'________ ____
----------------•------------------..•--..-•------••------•.._.................-••••----•-•------._.._..--•-•--•--•---------•-----------------.......--------
D Description of Soil........ ' /2 .-/AW N �&-p. Sia i
. . _ . __ -
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 i T�s- - 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the b and o health.
�j %
SigneA�t �. .........°--.......................................-
____
r•_.,...�-.,�-'--, ate
Application Approved By.................. ......... _------------------- ---- f at -----
Application Disapproved for the following reasons:------•-----------------------••----------------•------•----....---------------••------•----•-•----•--........._
....-----•------------------------------•-•-----....---------•---•---•-•-•-•---------•--------------•._...__....._.._•---------••------- •-•-----------•-------------------------------------•....-----
Date
Permit No.. ..__.�...........r
Issued.................------------------------
,r
--------------- Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD yOF HEALTH
7_^.�.Al......-.OF......... �................................
Tatif iratr of Toutpfiattre
THIS S 0 RTIFY, That the Individual Sewage Disposal System constructed p, � or Repaired ( )
c
Installer
at ............................ _.: 'C. t' !--� �•-----•----------------------•-----•.-•......--•-------------
has been tailed in accordance with the provisions of iT" 7 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No__________________IZ-P�/--------- dated.....-----------_---------...............:......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.,.................. 7-------------------------------- Inspector...-•-- .... _ -"" ------------------------------
S�/ THE COMMONWEALTH OF MASSACHUSETTS
(jJ BOARD,pOF HEALTH
I-/,A/-.....OF.......eg!A 2�z•�5Z' tg!�..__..._..._ �J
T4()-q ................ . ..._....-._....._.. •-._
No.---....--•--•-------..._/ FEE............." •-•-
Disposaf Vorhg Tonstratiott an it
Permissionis hereby granted------- C-0:............••-•-------•------•---------------•-------------------------------•---•---.._...............•---
to Construct (i�'") or Repair ( ) an Individual Sewage Disposal tem ,
atNo..............., r Z � ). � ='` a ................................................
Street�7
as shown on the application for Disposal Works Construction Permit �%?c?�1_- Dated._11__.__( ........
! / ""_7_ J_ Board o[ Health
DATE'--=mac-- --•-•--------•---•----...-•------G•-••----�•---C--P_-••....:....::::::.__`,"'+ Ri
FORM 125 i�&BBS & WARREN, INC.. PUBLISHERS
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LOCATION
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SCALE . .l��:' ?�.... DATE .MOV-3 0784
PLAN REFERENCE
c.fz7- .. . LAB-'. . .. .. .
���`��o► Kassa .. c, s �� ��� . . .Z,G��- /0 6. . .. . . . . . . . .. . . . . . . . .
o EDWARD
�rE j-EY I CERTIFY THAT THE
�61CC E GROUND
.
.�.�, � SHOWN ON THIS PLAN IS LOCATED ON THE GROUND
�f6r AS SHOWN HEREON;
DATE . .. . ... .. . . . . . .
REGISTERED LAND SURVEYOR
SNP' Z `off Z .SNEz�7'S
T1
,f
TOP OF FOUNDATION
CONCRETE COVER
e,
Z CONCRETE COVERS
3,34E .e 4"CAST IRON 12"MAX.
OR SCHEDULE40 12"MAX. •
P.V.C. PIPE 4"SCHEDULE 40 PV. (ONLY -1f
PITCH 1/4"PER. PIPE- MIN. LEACH
PITCH 1/4"PER.FT. PIT PRECAST C
o' INVERT o 'o a LEACHING
EL.l.6: ... INVERT INVERT o . �i Q•t PIT OR
SEPTIC TANK EL.��-B9 DIST. �_ EQUIV.
INVERT BOX -
. /✓�cc. .... GAL. INVERT
EL1S7z INVERT ww o• �:�. 3/4°T011/2�
ELAS/.o e.' �o �: WASHED
STONE
lip
DIA.:�q rZXAZ
PROR LE OF GROUND WATER TABLE
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE OP. /I,!W TIME. /47P9 A11 `�Ar?�-' . �-a"� ^! BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 ENGINEER
ELEV. . . /L:6o. . . ELEV. .
Goss-r � . . . . . . . . . . . . . . . . .
Fr
`t"� DESIGN DATA :
E2 c o 24 76 3
� /4¢0 NUMBER OF BEDROOMS
TOTAL ESTIMATED FLOW . , 3.3o GALLONS/DAY
hE� BOTTOM LEACHING AREA . . SO.FT. /PITIG.P.A,
SsnvA HAD,
S/Yiyp SIDE LEACHING AREA . . .�8B S. . . SQ.FT./ PIT/47/ c.P.D.
GARBAGE DISPOSAL .(50% AREA INCREASE)
TOTAL LEACHING AREA .-30%6 SQ.FT
144 E1.4.Lo PERCOLATION RATE 4- 5S Q MIN/INCH
" /3Z" E_z. S�
.!VP .WATER ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .•'�-/. SQ.FT1. CAD,
NUMBER OF LEACHING PITS . ON P;T �N/77,1
APPROVED . .. . . . . . . . . . . BOARD OF HEALTH
DATE. . . . . . . . .
AGENT OR INSPECTOR
OF
1l / i
T i'zG E_ JUp�.o
I(ELLEY N 't
GALI2lSo•cJ GN• �. O. 26100 o k �o F STEV`��
�I
dS7Z�7Z1//l ss��f�ISTER�° ` s�yn►.a���/`c'.
LAt1D
PETITIONER 20ge7?7 /:oW672S 'l �'"-