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Home My WebLink About0464 STARBOARD LANE - Health 464 Starboard Lane, Osterville A= 167-025-002 r ,i d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owners Name infomration is Ostervilie MA 02655 12-28-12 required for every page Cityfrown state Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General InformationfiWlDg Cut uuuuuur�� on the computer, j ```��` OF PfqS�4ii��. use only the tab 1. Inspector: key to move your JAM ES u' cursor-do not use the return .lan7eS D Sears key. Name of inspector Capewide Enterprises LLC % � _ sao•' Company Name 153 Commercial St ryUnm�uN SpE��` Company Address Mashpee MA 02649 City/Town state.. Zip Code 508-477-8877 S 1623 Telephone Number License Number ra —1 Q r. C3 -I C,...wp 4.,tiJ •�v . B. Certification I certify that i have personally inspected the sewage disposal system at this address and that tW information reported below is true, accurate and complete as of the time of the tnspectior The inspection' po -•-t was performed based on my training and experience in the proper function and maintenance ofmn site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section.}15.34'b of Title 5(310 CMR 16.000).The system: r ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-28-12. ;ns�pe�ctoftessigature Date _ _---- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaEth or DEP)within 30 days of completing this inspection. If the system is a shared system or j has a design now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under j the same or different conditions of use. [Sins•r 110 Tine 5 Official Inspection Form Subsurface Sewage Disposal SYStem•Page i of 17 Dec 30 12 09:26p p.2 Commonwealth of Massachusetts immal Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owners Name information is Osterville MA 02655 12-28-12 required for every page. City/Town State Zip Code Date of inspection B. Certification (cont.) Inspection Summary. Check A,B,C,D or E!always complete all of Section D A) System Passes: ® 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. Check the box for'yes"."non or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal.septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below). 15ins•11110 Title 5 Official Inspection Fornt Subsurface Sewage Mposel System•Pape 2 of V .Dec 30 12 09:26p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 Starboard Ln. Property Address Alvin Silk Owner Ownees Name information is Osterville MA 02655 12-28-12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high,static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N L] ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broke_n or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance wlth 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 orr-a salt marsh t5insr f/t 0 Tula 5 kcal fropecriat Form:Subsurface Sewage Disposal System-Page 3 of 17 Dec 3012 09:26p p.4 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarHoard Ln. Property Address Alvin Silk Owner Owner's Name information is Osterville MA 02655 12-28-12 required for every page Cityfrown State Zip Code mate of Inspection B. Certification (cant.) 2. System will fail unless the Board of Health (and Public Water Supplier,N any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. Q 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 oT more from a private water supply weir*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No Q ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in ranowl is less than 6" below invert or available volume is less than day flow 4i7S t5ins•11110 Tide 5 Official Inspection Form:subvi face sewage Disposal sy>tam•Page 4 0117 Dec 3012 09:27p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address . Alvin Silk Owner Owner's Name information is Ostervllle MA 02655 12-26-12 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high 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. [Phis system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes' or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. t5ins•1111Q Title 5 OFfidal Inspedfi n Form:Subsurtaw Sewage Disposal System-Page 5 of 17 Dec 3012 09:27p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. kwo Property Address Alvin Silk Owner Owner's Name information osterville MA 02655 12-28-12 required for every page. cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no'as to each of the following: Yes No ❑ ® 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 NIA) ❑ 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 site and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure-criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: 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): 440 t5ins•11110 TRIe 5 Olfidal Inspection Form Subsurface Sewage Disposal System Page 6 or 17 Dec 30 12 09:27p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owners Name information is Osterville MA 02655 12-28-12 required for every page Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal precast tannk D box and two 1000 Gal pits 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes .® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes M No Water meter readings, if available last 2 ears usage d 2011-247,000Gal 9 ( Y 9 (gP )) 2012-244,00OGal's Detail: Sump pump? ❑ Yes No 'Present Last date of occupancy: Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ss� vo Title 5 Official insped ian Form,Subsurface sewage Disposal Syslem Page 7 of 17 Dec 30'12 09:28p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Osterville MA 02655 12-28-12 page. Cityrrown State ZJp Code, Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records. Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval_ ❑ Other(describe): t5ins•11110 Title 5 OWN Inspeaion Farm:Subsurface Sewage Disposal System•Page 8 o117 Dec 30'12 09:28p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Cisterville MA 02655 12-28-12 page. CitylTown state Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System NA 1 New pit 1993 permit#93-370 New D Box and line change 12-28-12 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 20" Depth below grade: teat Material of construction: ❑cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 1, feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes [] No Dimensions: 1500 Gal Precast Sludge depth: 2" t5ins•11110 Tine 5 Official Inspection Form Subm rface Sewage Disposal System•Page 9 of 17 Dec 30'12.09:28p p.10 Commonweailth of Massachusetts Title 5 Official Inspection Form > Subsurface Sewage Disposal S_ Form- Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Ownsr's Name mfl u.ired for is Osterville MA 02655 12-28-12 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 8" - Distance from bottom of scum to bottom of outlet tee or baffle 1 T How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee-or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level w 1 in and outlet tee's, Tank and covers at V below grade, No sign of leakage or overloading I Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 50fficial Inspection Form'Subsuftw Se*Age Disposal System-Page 10 of 117 Dec 3012-09:29p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Osterville MA 02655 12-26-12 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction'. . ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene []other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condirtion of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t51ro•11/10 Title 5 Of iciai impedion Fore't Subs 63CO Sewage Dispose)System•Pepe 111 C`I 17 Dec 30 12 09:29p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Osterviile MA 02655 12-26-12 page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-2' Below grade w/cover at 6". Box is clean and solid w/two lines out_ Box is new 12-28-12. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-7'Fl70 Title 5 Official Inspection Form'.Subsurface Sewage OlsposW System-Page 12 or 17 Dec 3012 09:29p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Osterville MA 02655 - 12-28-12 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ 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.): Leaching is two 1000 Gal precast pits. Pit( 1) H-10 under brick walk way w/cover at 8",2'water, stai line at 30" Pit(2) H-20 in stone driveway, pit at 30" Below grade clean and dry. No sign of over loading or solid carry over in pits Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration _ Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Gins•11110 TNe 5 Official Inspection Fam:Subsurface Sewage Disposal sysrern•Page 13 of 17 Dec 30 12 09:30p p.14 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is Osterville MA 02655 12-28-12 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cons.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): 15irs-11110 TRIs 5 Offidal Inspection Form:Subsurface Sewage oisposaS system-Pago 14 0117 Dpc 30 12 09:30p p.15 V Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owners Name information is MA 02655 12-28-12 required for every Osterville page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately C' A 14 2-7 R -�L= 37' -3 3 ? _ a�=� n'�J 1/ 3 ° - C y= 3 o� 1 i w �V t5ns-11110 Title 5 oMcjW Inspection Fonrc Subsurface Sewage Disposal System•Pegs 15 d 17 Dec 3012 09:30p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln_ Property Address Alvin Silk Owner Owner's Name information is required for every Osterville MA 02655 12-28-12 page. Cityrrown State Zip Code Date of Inspection D. System Informatioh (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N 0 Estimated depth r.high ground wate 13' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Area High, Hand auger 13' No G.W., Auger hole 4' below bottom of pit. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11110 Title 5 omdai inspeaon Foray si u eace Sewage Disposal System•Pop 16 of 17 Dec 3a 12 09:31 p p.17 Commonwealth of Massachuset#s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 464 StarBoard Ln. Property Address Alvin Silk Owner Owner's Name information is required for every Osterville MA 02655 12-28-12 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file [Sins•11110 Title 5 Off c"inspection Forrm Subsurface Sewage Disposal Sptern-PaQe 17 of 17 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION '-t � �i 1�1[2•�'rVy1r) C,�A-�2: SEWAGE # � VILLAGE (�5 t � �-tt "'�- ASSESSOR'S MAP & LOT D03 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ( ►'Y Eo�?s f T� (size) NO. OF BEDROOMS PRIVATE WELL OR P R BUILDER OR OWNER- XE�,N v v,"t Cy DATE PERMIT ISSUED: DAT-E COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 0 r http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 67025002&seq=1 7/22/2013 No. ZO I Z^ U 10 Fee ' /OE, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2[pplitatlon for Disposal *pstrm Const ctlon 30Prmit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.l{64 S10MR00ft L0 Owner's Name,Address,and Tel.No. 7 A t.�e!�v S t c.t� Assessor's Map/Parcel 0;L 15T94k8014 p ! Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. lA00w1Dc mj�w1,5" L&-C_ 153 ST- 614VE67 Type of Building: Dwelling No.of Bedrooms /v Lot Size a,�a� �. Garbage Grinder( ) Other Type of Building RE51D&WT1 T}C_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) PA gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer /when applicable) !�{� 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 Healt Signed Date oZ'v1�'eZV Application Approved by Datea Zfo LZ Application Disapproved by Date for the following reasons Permit No. Date Issued I � . No. ZO I Z L4 10 Fee /L9D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal 6pstem: Construction 30Prmit Application for a Permit to Construct( ) Repair()o Upgrade( ) Abandon( ) ❑Complete System X Individual Components Location Address or Lot No. Io�{ S- � V�( �� Owner's Name,Address,and Tel.No. ®STt�v du� `� AJ S t '.tt Assessor's Map/Parcel 1(01 v X W 5T k130*'1_ (A (p 51 lUfC�C Installer's Name,Address,and Tel.No. 509-4"i 1-8g'l-7 Designer's Name,Address,and Tel.No. 15-3 Type of Building: Dwelling No.of Bedrooms /V" Lot Size P 4'f$ sq t. Garbage Grinder( ) Other Type of Building [ZL:�;(D&W l r+(_.. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��` gpd Design flow provided IVA 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) Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in I 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 Healt u Signed Date —AG� 901 Application Approved by Date Z-6 �lZ. \' Application Disapproved by Date for the following reasons l Permit No. Date Issued ------------------------------------------------------------------- -------- ----------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( ) Abandoned( )by ��A PEW(Ve at 4 W STjAWQAft LA OJ& -0419MU-05 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2012'y I() dated 17�7_6 Installer ( fit ewtDE Designer ' #bedrooms NR Approved design flow N4- gpd The issuance of this permit shall not be--o�nsttrrued as aa')guarantee that the system witIf9C_ti`oWn s designed. Date f (7 b IJ/"/ Inspector -------------- --- ------------- --------------------------------------- No. HAD ws CJllanV Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem. Construction permit Permission is hereby granted to Construct( ) Repair( X) Upgrade( ) Abandon( ) System located at 4&4 JCMk?: L-A,J c— oSTeUtLLG 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 d"ate of this permit. Date �Z f /Za I Z Approved by Fi$.123 ............. THE COMMONWEALTH OF MASSACHUSETTS APPROVED BOARD OF HEALTH 0arnaaDme Cuero p TOWN OF BARNSTABLE Appliration for Diripoinl Worko Tomitrurfto rmit Application is hereby made for a Permit to Construct ( ) or Repair (V<an Individual Sewage Disposal System at: .................�lG q BARo�g10 (,� ........................... ••-• ................................. ----••--••--------••--•-••--•-•••----•••-.•--•---•--••---•---•--------------•-----------.......--- Location Address t No. � v Q Y` � O,c r .Ad res InAAJ staller Address Type of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms-9......................--------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -------------------_------ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- - d w Design Flow........i5- 7-115-------------------gallons per person per day. Total daily flow..... ......................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. -_.-- Depth below inlet_.....-......_.. Total leaching area..................s ft. 3 Seepage Pit No.....eo-x--( .. ....... Diameter._.l.�-... p f g q. Z Other Distribution ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date____._._................ .-------- ...._.. ,.a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0.4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••-•••---•-------------------••-•-••••--••-••-----••---•--•••••••-----•-•-••---•-•.........................--•---•--------•-•---•-----..._...----•-•------- ODescription of Soil........................................................................................................................................................................ x w Nature of Repairs or Alterations—Answer when applicable.--------F�'.19V--- l�..6 ._-_-_-•_- U ............ - - }Gp1.-s - v ------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee iss the board of4health. � Signe ......... ....... ...... .----`-`-`..... .... -............ .... ....... - �.:...` )-73 Dare ApplicationApproved By ........-- -.- ..-.-. --- --------------------------------------------------------------------------- ------ Application Disapproved for the reasons: .......... . ............................................ .................................................. ........................................--.................. . . . . ........................................ Dare PermitNo. .............)---------t6 7-_.----------------------.- Issued ......................................................... t Dace C:,.-..-+---"_---•L�`�•ba'- �.... •.or � Vs.«.�..ti.�•1....�,.... � a-4•-.w.-.:a&.;-. -w..✓•r.. -.b..a:-., a� r r +r.. ..u.9�..:,.Sa.. l..I..s'� *....i� J,r i•�-'�."_ ,�%..L�rw�....�•�,. "'^a=win.- i..'6 r�^..-...--ww..a.�l,J.�++.i•�'i'+.a1r,.,;..Y�.... �.r.+! 'Q `w No.._q` ��'- FEE... ` ............ THE COMMONWEALTH OF MASSACHUSETTS ,(a.0� BOARD OF HEALTH �D TOWN OF BARNSTABLE - Appliration for Di;ipwml Workii CnonMrnrtinn ramit Application is hereby trade for a Permit to Construct ( ) or Repair (V�an Individual Sewage Disposal System at: _`.. 1. . ...sa- R ._ , ........... ----- ...---.... ••---------------------- Location-Address orQf No. o'cncrr a Address..... ..........................rr � � Installer f Address Type of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms._9------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures .---•............................._---------------.-••--•------------.....----------.......---.........--•--•----•--------------•---..........._.. W Design Flow--------- �.T....................gallons per person per day. Total daily flow.. ..........................gallons. Septic Tank—Liquid capacity............gallons Length------'---------- Width---------------- Diameter.-.-.._.-.-___-_ Depth................ W Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----- Diameter--_:/.-O!,----. Depthlbelow inlet-----6:_!......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---- --------------------------------------------------•-•---------------. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit........_--_--=_`_._ Depth to ground water........................ fZ Test Pit No. 2................minutes per inch Depth of Test Pit........... ..___. Depth to ground water........................ 94 -----------------------------•-------••----------•-•---•-----•------•--•----------•--......---------.........................................................O Description of Soil........................................................................................................................................................................ W . .............................................................. ............................................................................................................................................ W ------....••------- -----------------•--•-•-•-•--•--.....----•-............-----•-----•---•---•••------•-•-------••----------•------•-----------•-----------•---------•--......------------•---.....-- U Nature of Repairs or Alterations—Answer when applicable.........4-01_------s�r ./�(:.�-.,.,...../,,,,_/t?7,7-) 7!,T'--. ............&414 �_' T�l:r- _.. ?_ ram„ �,_:� --�,, 1. c= `--------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued,by the board of health. Date Application Approved B ..... 7........ . ....-,�1.... Date Application Disapproved for the following reasons: . ............................................... . ............ ................................... ......................... .............. ......................................... ... ......... ..............::. ........ .. .- . ..- .................. ............ ........................ Get Date PermitNo. ....... i..- .7..(.)---..------------------- Issued ........................................................... ...... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifiratr of (fompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by r........................... � .ID- ...... •..r�s z. r IW tl _: ........ ._ . ..... ......_............. ..-_........ --------------------------------- ........ Insmllc•r at ........................................ ram...... . -..... tfI .r.-- <' -'?. .a `..''C ....;:..........................._... _ _ _ has been installed in accordance with he provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._.c ._ ............ dated ............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............_7.....��.. -- ..�/... .............._.. ............._.. Inspecwr ........ - ............•- ......................... ------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ��----37z)- TOWN OF BARNSTABLE No... FEE.----s lJ......... Disposal Vorkv Tunitrurtivit Vern it Y g l / -'---- -------------- ------ tois hereby ranted................. �_.��° :...±. ?r__=j '" to Construct ( ) or Repair ( L)_an-Individual Sewage Disposal System atNo.......................... et as shown on the application for Disposal Works Construction Permit No.,yn .'A Dated........................................... — �L .................................. �` ✓ Board of Hcalth DATE................. "-- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS I TOWN OF BARNSTABLE LOCATION Lf, :� �I l�(ZAII ey SEWAGE # VILLAGE STeo�� ASSESSOR'S MAP & LOT obi. DOI INSTALLER'S NAME Si PHONE NO. CA UOW sic. SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) 4�'�6 NO. OF BEDROOMS PRIVATE WELL OR P IC � l/'_ BUILDER OR OWNERS � Cv mow "J9 DATE PERMIT ISSUED: .. 9 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t/ .�(,-e((C� .. 1�2 01 a r r f1�-cud 1000 'E+-au P;j c� Ia' r ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH owl. ............OF............ a.45T ............................ Appliration for Dispn.ittl Works Tnntrnrtiun Prrmit Application is hereby made for a Permit to Construct (V ) or Repair ( ) an Individual Sewage Disposal SySV . l� ko -kd �Ah ¢./ ....... .. •....... ._ .. ......... ...... ......�.�.. .. ..__..._...........-.-..j...---------- LJ. '•A re ;�,or t N� r� _ ... ..... i .. :.................... ..---...-- --...... ..... 1 : �/ ° -:.. .....--.--- �r .......... Owne Address .. Installer Address / p�Q . dType of Building Size Lot._(_'d! .............Sq. feet V Dwelling—No. of Bedrooms.......... ... Expansion Attic ( ) Garbage Grinder H ..................... '4 Other—Type T e of Building w ............... No. of ersons.................•...__.__.. Showers — Cafeteria a YP g ------•-••--- P (� ( ) a' Other fixtures .............................................- d --------•••.....-•..... Design Flow..............- gallons per person per day. Total daily flow.._... F.......--...................gallons. WSeptic Tank—Liquid capacity.4rrgallons Length................ Width................ Diameter__._:___.•_____- Depth................. x Disposal Trench—Nq..................... Width�.Z............ Total Length............... Total leaching area....._y��. ...sq. ft. Seepage Pit No.......... .......... iameter...... _....__..... Depth below inlet......&....... Total leaching area_--:.__..._.�..sq. ft. z Other Distribution box ( "') Dosing tank ( ) Y �-11 ......klomj .... ._ 16 Percolation Test Results Performed b .._ _... Date:___ ._.,/Test Pit No. I._....4._..minutesperinch Depth of Test Pit.......1Depth to ground water....../2_Y7_ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ...............p... -- O Description of Soil......... [5'r 4T_...-•••' !sfl,...............( ........ -ijij x ..--••-•--------------------•-----••---••---•...._------------•---•-.....--- ............._------......... UNature 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 iIHE 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 board of Health. igned.. ....................... =. ...-----•-•------•--•............... ..... ..... ............. ApplicationApprove y. ................ ..........•••--------•-•---••--•-------•---.....--••---•--------••.------ Y f Date Application Disapprov or the following reasons:................................................................................................................ ......................•--•----•-•....................----••••---•••-•-••••---------...----...•-••-...................................------•-----..........-•---•-••-••••----------•-----••--•--•--.-•--- Date PermitNo......................................................... Issued........................................................ Date ---- - ---- - ------ - -- ----- ----- --_— _— __J ............ No.0...ZZ2.1.. THE COMMONWEALTH OF MASSACHUSETTS BOARD...tHEALTH -5 .................. .......OF....... ........ Appliration for Uhivoiial Workii Tatudrurtion Prrutit Application is hereby made for a Permit to Construct V'�or Repair an Individual Sewage Disposal System t ... ...... bX�0. ................... . .Z_ t�i --, or ca .dd 4......J.V -------------------------------------- ............. �ow n.e.r, Address ................................. . . . ....... t. 77t............. .................................................................................................. Installer Address M �;Type of Building Size Lot..J. .........[ 4C.....Sq. feet U Dwelling—No. of Bedrooms... Expansion Attic Garbage Grinder (X) P14 Other—Type of Building N_o f �on,�t p,,e r o n s,.-n........................ Showers Cafeteria Other fixtures ....................... --------------------------------------4- -- ---------.......*-----------........ s en., '�rson per ay. Total daily flow_.._.._ . .........Design Flow.............. le M."Mr --- -------------------gallons. 1:4 Septic Tank—Liquid 0gallons Length................ Width........_._..... Diameter__-___...._..... Depth................ Disposal Trench—No. ................... Width....____....._._._.. Total Length............ Total leaching area............... sq. f t. > eter.......1��.... Depth below inlet_.____?-....... Seepage Pit No---------- ... lam Total leaching area.....a.3.2"::sq. ft. Z Other Distribution box ( -e Dosing tank ( ) Q� Percolation Test Results Performed b %_'_ 04 ...... Date...l ...... Test Pit No. I...... Depth of Test Pit......... .-Z._Depth to ground water......k;2�"/9�` ----minutes per inch V4 Test Pit No. 2................minutes per inch Depth of Test Pit.___._.........._.. Depth to ground water....................__-- escr on o o Description Soil.........�D 0 ... nl.�o.......................................... ----------- --------rMj U ........... ............................................................................................................................................................................................ W 1r: -------------------------------------------------------------7.......................................................................................................................................... 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. igned........................................ ............................................ .......... .Dater — .,_ Application Approve .......... e . . ...... .. ........................................................................ ........... Date pp Application Disa ro or the following reasons:................................................................................................................. ...............................................................7.........................................I.............................................................................................. Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH ...........Towv�....C ............ ............................ Trrfifiratr of Tuntpliatta THIS IS TO CVRTIFY That the Individual Sewage Disposal System constructed ( �or Repaired by-------------------------------------aeel.�.................................................................................................................................................. Installer at..................................................................................................................................................... ................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code Asdesc/ribed in the japplication for Disposal Works Construction Permit .... .............. dated_,� ..................... THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM ew 1 ,FVN TION SATISFACTORY. L DATE..... 2- ............................................................. Inspector........ .... ................................................................... THE COMMONWEALTH OF MASSACHUSETTS T BOARD �F HEALTH .................... ..W .....OF......... FEE.65.................... R11111111a1 orkii notrmfion ramit Permission is hereby granted.............4�6 540 �........................................................................ to Construct ( ) or Repair ( ) an IndividualAewage Disposal System atNo............................................................................................................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated.._....__._._...................._......... ......................................................................................................... Board of Health DATE.....................9 ----------..--------------------------- FORM 1255 A. M. SULKIN. !NC., E30STON Al 10 SEWAGE PERMIT NO. uLLAGE i I III STA LLER'S' NAME i ADDRESS 00, i R:U It D El OR OWN DATE PERMIT ISSUED DATE_ COMPLIANCE ISSUED � � `� __ �� /��p . . �� . , , .. 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