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HomeMy WebLinkAbout0133 ABLE WAY - Health -Y- 133. Able Way Marstons Mills P A = 046 111 rr ,r 10, TOWN OF BARNSTABLE LOCATION � bW019SEWAGE # V I LAGE ��r��n- ma « ASSESSOR'S MAP &'LOT N(0{ If INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY n, LEACHING FACILITY: (type) (size) 1 00 0 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: n Sp-C Ct 0 o 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) j TIC Feet Furnished by J Aco 'a becK aS 0 Co3L' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ❑ ' 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is required for every Marstons Mills MA 02648 July 23, 2013 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 filling out forms A. General Information on the computer, (� use only the tab 1. Inspector. \: key to move your �� cursor-do not Kevin J. Sullivan use the return Name of Inspector key. Ready Rooter, Inc. VQ Company Name P.O. Box 371 fA Company Address Sandwich MA 02563 City/Town State Zip Code 508-888-6055 SI 13517 Telephone Number License Number V B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority August 8, 2013 Inspector's Signat re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """'This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Marstons Mills MA' 02648 Jul 23, 2013 required for every y page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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 be replaced or repaired. The system, upon completion of the replacement or repair, as proved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following st ments. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whe r metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure ' Imminent. System will pass inspection if the existing tank is replaced with a complying septic nk as approved by the Board of Health. *A metal septic tank will pass inspection if it is structur y sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 ars old is available. ❑ Y ❑ N ❑ ND(Explain low): I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 23 2013 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 bo due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. S tem will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain low): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Expl n below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(E plain below): ❑ The system required pumping more than 4 times a year d e to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Boar of Health): ❑ broken pipe(s)are replaced ❑ ❑ N ❑ ND(Explain below): i ❑ obstruction is removed Y ❑ N ❑ ND(Explain below): C) Further E/tshystesem n is Requir by the Board of Health: ❑ Conditionhich requi further evaluation by the Board of Health in order to determine if the systeng to pro ct public health, safety or the environment. 1. Systeass less Board of Health determines in accordance with 310 CMR 15.303(1) th ystem is not functioning in a manner which will protect public health, safety an ronment:C or privy is within 50 feet of a surface water C or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is required for every Marstons Mills MA 02648 July 23, 2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Xy ater Supplier, if any) determines that the system is functioning in a manprotects the public h th, safety and environment: ❑ The system has a septic tank and soil absorpti (SAS)and t SAS is within 100 feet of a surface water supply or tributary to a surf supply. ❑ The system has a septic tank and SAS and thithin a ne 1 of a public water supply. The system has a septic tank and SAS and thit n 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is 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, ormed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the pre ce of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no othe ailure 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 ❑ ® 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 23 2013 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility ith 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 followin , In addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface inking water supply ❑ ❑ the system is within 200 feet of a ' utary to a surface drinking water supply El ❑ the system is located in a nit en sensitive area (Interim Wellhead Protection Area IWPA)or a mapp Zone If of a public water supply well If you have answered"yes"to any questio In Section E the system is considered a significant threat, or answered"yes" in Section D above a large system has failed. The owner or operator of any large system considered a significant thr under Section E or failed under Section D shall upgrade the system in accordance with 310 R 15.304. The system owner should contact the appropriate regional office of the Depart nt. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner owner's Name information is required for every Marstons Mills MA 02648 July 23, 2013 page. City/town 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 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: ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011-34,000 gal= 94GPD 2012-46,000 gal. = 126 GPD Sump pump? ❑ Yes ® No Last date of occupancy: January 31, 2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Ions per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged t e Title 5 system? ❑ Yes ❑ No I Water meter readings, if ilable: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Marstons Mills MA 02648 Jul 23, 2013 required for every Y page. City town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: January 31, 2013 Date Other(describe below): General Information Pumping Records: Source of information: No pumping records found I 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,d+etfffitttiem 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner owner's Name information is y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Second leach pit installed 1993 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: it feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 6"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: 8.5'x 5.5'x 4.5' 1000 Gallons 211 Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '<0 133 Able Way Property Address M.W. Enterprises Owner owner's Name information is y Marstons Mills MA 02648 Jul 23 2013 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 3" 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 12" How were dimensions determined? Tape measure and dip tube. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet Baffle concrete and outlet baffle concrete. Liquid level at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polyet ene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum t/boftof ffle Distance from bottom of scuee or baffle i Date of last pumping: Date Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Cityrrown 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/inspection) site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglas ❑ 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(condition f alarm and float switches, etc.): ttach copy of current pumping contract(required)..Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way ,p — Property Address M.W. Enterprises Owner Owner's Name information is Marstons Mills MA 02648 Jul 23 2013 required for every Y page. C4f'rown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of soli carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, /ition6fps and appurtenances, etc.): Soil Absorption System (SAS) ovate on site plan, excavation not required): If SAS not located, explain w y: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is y Marstons Mills MA 02648 Jul 23 2013 required for every , page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-6'X6'with 1'ofstone ❑ 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.): No sign of breakout or hydraulic failure above leach pits. First leach pit was empty with high staining above leaching area. Second leach pit was also empty with high water stains 1' up from bottom of pit Cesspools (cesspool must be pumped as part of inspection) (locate on site pla 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 groundwat Inflow ❑ Yes ❑ No f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of veget tion, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of h raulic failure, level of ponding, condition of vegetation, etc.): f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Marstons Mills MA 02648 Jul 23 2013 required for every Y 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 10 fir;v�WGY `� �J pecl�� © Q A 1 - z3 Z Z6 z- z� -66 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: New leach pit added in 1993 no other info available. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand augered empty leach pit to 10'total depth no ground water present. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 133 Able Way Property Address M.W. Enterprises Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 23 2013 required for every , page. Citylrown 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 --�D q-)z • ��lras — V{ ,poop -Aao V— C D o VA Q� C�U$QT J lv —ci —dc�13 r c', D I35 Tu OF BARNSTABLE Ij. ON b/ES 7jLGtA VILLAGEPa&70-0 ASSESSOR'S MAP LOT LJ G• �1/ INSTALLER'S NAME PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY %dr a LEACHING FACILITYAtype) Z p m o o (size) NO. OF BEDROOMS 3 PRIVATE WELL OR UBL WATER BUILDER OR OWNER DATE PERMIT ISSUED: 7- 7 3 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �C ® 0 � . ti 9 P i _ . � ����-,� , is TOW�Np�OF BARNSTABLE LOCATION SEWAGE # VELLAGE `� ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /w LEACHING FACILITY: (type) V/ (size) NO.OF BEDROOMS, BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by s�•( (QU c Nil I � A fiA ,3 LLg Q c Aa d� a as c� 36� X D q6 33 l! 1 t/ No.... l��r B,S.....�.G....^.. THE COMMONWEALTH OF MASSACHUSETTS ao BOARD OF HEALTH G=`r' C= M�, � TOWN OF BARNSTABLE - VW-al .� Dirip t ial li urkii Cnomitru ;rmit a� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal C rMe, Type : .. ......Abl..........W. .....--. .-1------- ---------- .....--------------------...... 1 ..... /X s----•---- .... � EJ_I.a... No. ............................... owner ).._.... �a .cv---------------------------------------------------- .� met�:► ` � .. �...... Installer Address uilding Size Lot............................Sq. feet V Dwelling— No. of Bedrooms---------.. ..................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------- W Design Flow............................................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. 3 Seepage Pit No--------.-_---.---- Diameter-------------------- Depth below inlet.................... 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...'77` ...... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -•••------------------------•-•-•-•-------------------------------.......---........._......---•---•......................................................... ODescription of Soil.............................•-•-------------•-•------...............---•---------------.....------------•-----•--•-------------------..................----............ x W -•••--------•--------------------•-•-------•----...---.....---------------------......-----•-•----•------•----------------------•-------................-- ---------•--••.............. -, UNatur�e�,of Repairs or Alterations—Answer when applicable..-.��?. fa_It.--_---....... .p...�a�?.Q.....� ... 1�>"It .. . . � � � � �� ..... .s5 ...... ..fit t...................................................................... 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 h4 been i ue the board of health. Signed ................. .. -........................ 7-a3....V.:...... Dare Application Approved By ----------- .. ...7 r.' Application Disapproved for the following reasons: ................................ . ................................................... ........................................ ................. .... . ................. . ..... ..... Dare PermitNo. ?• . ......................... Issued ................................................... Dare __.��7 , �`Fxs...._��G............ No....�� THE CO COMMONWEALTH NWEALTH�OFUASSACHUSETTS BOARD _ Of HEALTH TOWN OF BARNSTABLE - 3- S 3 irtttivit for Diripimul Wurkg �G(L2 Application is hereby made fora Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ------ Lo,mion-Address ' • t No. -: Owner Address --_-•_.. _.. --•-----•--••-•...... Installer Address 911 Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.--______�?_______________________---_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---___.__.-__-___.-__------- Showers ( ) — Cafeteria ( ) aI Other fixtures ------------------------------- - - Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width--____._.-..--__ Diameter................ Depth................ r x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------------- ------ Diameter......_............. Depth below inlet.................... Total leaching area..................sq. ft. 1 Z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed by__________________________________________________________________________ Date........................................ a Test Pit No. 1................mtnutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ._...---•-------------------------------••--------•-----••-----....---•------•-.._..........---•-•-•......................................................... 0 Description of Soil....................................................................................................................................................................... x V .....-•••••................•--••--•-----••------•--•-•---•-•-------•-•-•------••--------••...-------•--•••--•-----------•--•-------------•------•-------•--•--•-•--•••-••--•....--•...-•-•-.......-••--- W •--••-•------------------------------------•--------------------------------------------•-------------------------....---------------------•-------- . .•-_.... U Natu of Repairs or Alterations—Answer when applicable.__ !2_Sfa-......_._ ._-___.....__.P___..UO.G?__-_1.�� -_•-._�-1�oy�� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with i the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the i system in operation until a Certificate of Compliance has been is ue by the board of health. 1 _ 1 Signed ...................... .... ..... ........ _-------_---- .....�..1_3e-.��:...-.. Application Approved B ................................................... ............................... '7.�. .... ....-..��°..�, Dace Application Disapproved for the following reasons: ...................................... .................... ................................_................................... .................. ....................................................................... ........... ........ ...................-- ------..................................... ... . ................................ Dace PermitNo. ...... 3.......3.7_- ---- -- ------------ Issued .. .--........................................................... Dare THE COMMONWEALTH OF MASSACHUSETTS~ BOARD OF HEALTH TOWN OF BARNSTABLE QVIPrtifirate of TIImplilinre s THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( �) by ......... t.8.......... i9l7e a.._..................._......... .............. ..............._.. ............. -- . ............-.................................................... Inscuner 4 at ..../.,�l%.. /............/-f h C t.,44l ........MC11YA-0.......... .C/.LS. .. ..................................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ----..73..-._37,......__._ dated ..... ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. -�� DATE........._.......�1..'. :. .........._._._.._._._.... .. ............. Inspector ...__....... ..... >.... ........... ............_.... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE.---.30.... �t��n�tt1 �rk� �ua��tr�#irin �Prmi� , Permission is hereby granted ?` d---------------------- -_--------- ......................................... to Construct ( ) or Repair an Individual Sewage Disposal System , at No...A= ..-•-._ _.._ ( _.. is !.........?7-Ie&s-------------------- Street as shown on the application for Disposal Works Construction Permit No._ — 7 _ Dated.._,;n,. .. ....... ---------••-- ----- DATE. ! �. �. --------------•---•------- Board of Health FORM 36508 HOBBS R WARREN.INC.,PUBLISHERS LQ j 7 77 LOtCATION / / SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS �C� Co �, r T 215- J.3 6; Z B U[LDE R OR OWNER DATE PERMIT ISSU f D _ 2s"- 7Z DAT E COMPLIANCE ISSUED 77 r i ,, , -� , � �� 3 � � 3 `� � P No........ Fu$../,`��................... THECOMMONWEALTHOF 1 flMASSACHUSLE',TTS BOARD I-7 J � ► � f /� .........OF...... ..... _: .. Appliratiun -fur Uigvuutt1 Works Tonfarurtiun Vrrmft Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systemat ---•--•------• -----•--------------------------••-••------- o lion-Address �.i or ) ��� -•---........................ •---2-•-••••------••-•-•-•- ••••- .._ - s_fr.�i _R•--•------------ ----------- w er � Address. Installer Address d Type of Building Size Lot............................Sq. feet U - � Dwelling—No. of Bedroom ___--_-. �?__------------------------Expansion Attic ( ) Garbage Grinder Other—Type of Buildin "� -�-___ No. of persons____________________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------- - - W Design Flow_......_..!`Q_________________________gallons per person per day. Total daily flow.............. ----C--_-__-___.._......gallons. Septic Tank—Liquid capacity°_....____gallons Length________________ Width................ Diameter_.___..._._-_... Depth._.._.-_........ T Disposal Trench—No ____________________ Width_.._______. _ _ __ Total Length------------------.. Total leaching area--------------------sq. ft. Seepage Pit No......I_........... Diameter_/6_®m_�>__ below,inlet____________________ Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0 1— 'Ove — /r' - 1-7 — 7C aPercolation Test Results Performed by------____---_--•-•-------------------- ----•--•-----•--•--••-•-•-• Date.................•----•-- -------- Test Pit No. 1................minutes per inch Depth of Test Pit----------------!_-. Depth to ground water........................ fi Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water---.--_-__--__.--_-_-.-. a -•------•--•-- k -e - { Description of Soil �`.. 10 `�" --------- �----- ----- ----2` 1 d'rr P J ----� x W -------------- ---------------------------------•--------•-•-----------•••••••--••---•------•--------------••-•------------------••••••-•---•-•------•---•---••-----•• ------- -----•---•-------------- 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by the boarcle�alth. --- -_ �,�,�„�------------- ��V------ Sin Date g •---- ----- Date Application Approved By `' ' �.___ ......... .. - ----------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- •--••••-••-•-•••••----••----••--•---•--•-•-••-•-----•---•---•••--•-•--•-•••-•••-----••••••-••-----------•.. Date PermitNo......................................................... Issued........................................................ Date No........ Flms............................ _ THE COMMONWEALTH OF MASSACHUSETTS BOARDf'� F H H a � . --------OF_z ........:......................................................................... -4 'Application -fur Uiii :Qwttl Workii (ftonstrurtinn Vrru it Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at, ......"' -___-o .ion-Address or o. t I� ................ w er.:> Add -. ........... Installer 4Address PQ d Type of Building Size Lot............................Sq. fe t U Dwelling—No. of Bedroom _ --.--Expansion Attic ( ) Garbage Grinder �i 0 a, Other—Type of B,tlildii �. ... No. of persons----------•----------------- Showers ( ) — Cafeteria ( ) 0.1 Other fixtures ------------------------------------------------------ W Design Flow...........4' 4 _ ........................gallons per person per day. Total daily flow............. d..................gallons. 9 Septic Tank—Liquid capacity_!.--_-__-gallons Length________________ Width................ Diameter------.--------- Depth.._.---._-.-...- W x Disposal Trench..fi No_ ____________________ Width___________ _. Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No._____ Diameter./��� ^�+k below inlet_ .._._. ... Total leaching are a.-----._-----____sq. ft. /------- ' Ts . Z Other Distribution box ( ) Dosing tank ( ) G X �Pe;a /.t•/1 74 aPercolation Test Results Performed by------------- ------------------------------------------------------------ Date.._--=---------------------- ........... 04 Test Pit No. I................minutes per inch Depth of Test Pit-.-_.-_____________ Depth to ground water......---------.--.--_ r4 Test Pit No. 2................minutes per inch Depth of Test Pit.....:.............. Depth to ground water------.-.__..-.--_--.--- --- - --------- _ _. ._ _ r_ ................ . ,� , >--------- - &-s- i---. f --- Description of Soil ' �` fi G r` 4ce— '-��--�` � d" x sty c� ---------------------------------------------=---------------------------•---------•---------•-------•---------------------•------.. W --------------------------------------------- -----------------------•-- -------------------------------------------------------------------------------------- --------------------------------- U Natur$of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------. -------------- t = Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to,place the system in operat on•.Ttil a Certificate of Compliance has been issu d by,the boar lth.. -- Sign ------------- ------- Da te Application Approved .+ 7_ y------- --- s 1 --- Date ..---- e .•---------•.......................................... _...•.. Application Disapproved for the following reasons:.................:................... f -------•---------------------------------------------------------------•---•----------------------•-...--•------------•-----•--•---- --------------------------------------------------------- Date PermitNo..................... -•-•-•--••••......•-•---•-..... Issued........................................................ Date r - 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ...... i!`ly ...........OF........ Q' L................................................... IvErdif irate of Tompliatta THI S T CERTIFY, That the Individual Sewage Disposal System constructed or ( ) by.. : •-- ---• ............. Installer ------- - - -- ---- - ------------------------------------------- .......................... has 15een installed in accordance with the provisions of A I I of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. ......... ...7........... ' dated.., _=:_ems--. `T__-__------ THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM.WILL fyNCTION SATISFACTORY. DATE...............-----......--y ....------. ......-- - � Inspector.------- --- THE'COMMONWEALTH OF MASSACHUSETTS BOARD OFZtHEALTH 77 4 6? No. ...�........ FEE--- .............. �i��o,�ttl � rk,� no�t��rortioit �rrottt . . Permission is ereby granted.n......__ ---------- to Constru ( or Repair ( ) I ividual Sewa����,�`,spo al stem at No..!,..,!.. '!�f �� --- - - y ? .... - ' Street - as shown on the application for Disposal'Works Constructioni—Per i o._._ __ .... .. ated.- `-..!7........................... Board of Health r DATE FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - r /e3. zz �o /3-4 • 'ro - - Iva f,r�� w•f� ,c3.c. �. ,13. Z73 e "Z i /°O /4 a d E WA � It CERTIFY THAT THIS PLAN SHOWS ' HE ACTUAL LOCATION OF THE STRUCTURE ON THE LAND AND �fAT IT CONFORMS WITH THE (��„Qa OF LANE) I 31Y-LAWS OF THE TOWN ommao ®v OF pmm Cam= .M D Z om S . i v CONERY CONERV '%� wy=m R� 6573 O t:a,E'+i8� jo G==== , e30M, AIA iS7 2