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HomeMy WebLinkAbout0088 LOVELL'S LANE - Health y 88 Lovells Lane, Marstons Mills A= 078-039 I o �I i 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: 88 Lovell' s Lane Marstons Mills Owner's Name: Victor Miller Owner's Address: Date of Inspection: e► r Name of Inspector:(please print) W i 1 1 i am E_ .Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1 089 Centerville, MA Telephone Number: ( 5081 775-8776 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 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 tion 15.340 of Title 5(310 CMR 15.000). The system: t� Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ] C a Z Date: " The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health of 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 conditions of use. Title 5 Inspection Form 6/15/2000 page I �I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Lovel l' s Lane Marstons Mills Owner. Victor Miller Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys m Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: $� s -- o B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep iced.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. An er yes,no or not determined(Y,N,ND)in the for the following statements.If"nut determined"please ex in. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent_System will pass inspect on if the exist' g tank is replaced with a complying septic tank as approved by the Board of Health. `A detal 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. Vaproval plain: Observation of sewage backup or break out or ldgh static water level in the distribution box due to broken or cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND xplain: 4The system required pumping more than 4 dines a year due to broken or obstttictcd pipe(s).The system will ppaassinspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND xplain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Lcyell' s Lane Mars tons Mills Owner: Victor Miller Date of Inspection: _ �'`1-6 -3 G Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or,a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the systeml is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic.tank and SAS and the SAS is within a Zone i of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front a private water supply well" Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: V 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 88 Lovel l' s Lane Mars tons mills Owner: victor Miller Date of Inspection: D. System Failure Criteria applicable to all systems: You ust indicate"yes"or"no"to each of the following for all inspections: Yes o _ 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 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 I00.feet of a surface water supply or tributary to a surface Awater supply. ny 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. y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private Aatcr supply well with no acceptable water quality analysis. (This system passes if the well water analysis, erformed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that(lie well is free.from pollution from that facility and (lie 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.] )cconsil'dcrcd /No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. ESystems: T 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: (Tlte 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 e 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-1WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E t}te system is considered a significant threat,or answered "yes"in Section D above the large system has fatted.The vwrrtcr 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. V6— 4 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 88 Lovell' s Lane Property Address: nnarstons Mi1]:s Owner: Date of inspection: -� FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):� Number of bedrooms(actual): C DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): U Number of current residents. 1' Does residence have a garbage grmder(yes or no): Is laundry on a separate sewage system(yes or no);� [if yes separate inspection required) Laundry system inspected(yes or Seasonal use:(yes or no): ,&e O Water meter readings,if available(last 2 years usage(gpd)): 2001 71 , 000 gals Sump pump(yes orno): /1.,a 2002 96,000 gals Last date of occupancy: ✓ COMMER IAIANDUSTRIAL Type of esta�ishmen'* Design flow ased on 310 CMR 15.203): gpd Basis of desiA flow(seats/persons/sqft,etc.): Grease trap pr sent(yes or no):_ Industrial wast holding tank present(yes or no):_ Non-sanitary ste discharged to the Title 5 system(yes or no):_ Water meter re dings,if available: Last date of oc upancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records ��� Source of information: Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPFF SYSTEM _ eptic 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 comilonpts, a installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Al U 6 Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 88 Lovell' s Lane Marstons Mills Owner: Victor Miller Date of Inspection: `' 6' 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) V _ 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 r - Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Lovell' s Lane„�; , , s Owner: viebor Miller Date of inspection: ./ D� e BUILDING SEINER(locate on site plan) Depth below grade: Materiallof construction:_cast iron _40 PVC_other(explain): Distanc/n-ts from private water supply well or suction line: Coma} (on condition of joints,venting,evidence of leakage,etc.): SEPTIC TALK:/(locate on site plan) Depth below grade: y/ Material of construction: Z'eoncrete_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) t Dimensions: `t; at f 0 Sludge depth: Distance Gom top of sludge to bottom of outlet tee or baffle: Scum thickness: 3 ) Distance from top of scum to top of outlet tee or baffle: Distance Gom bottom of scum to bottom f outlet tee or baffle: How were dimensions determined: i>�i-'O'L p ag rl Comments(on pumping recommendations,inlet and outlet tee or baffle conditicn,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): i GREAE TRAP:_(locate on site plan) Depth below grade:— Material o construction:_concrete_metal_fiberglass_polyethylene other (explain): Dimensioni: Scum thief css: Distance dOm top of scum to top of outlet tee or baffle: Distance om bottom of scum to bottom of outlet tee or baffle: Date of ast pumping: Comm nts(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as relalted to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Lovell' s Lane Mars tons i s Owner: Victor Mi er Date of lospection: V TIGHT or' OLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below ade: Material of co struction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: _gallons/day Alarm prescn (yes or no): Alarm level: Alarm in working order(yes or no): Date of last p mping: Comments(co dition of alarm and float switches,etc.): i Y DISTRIBUTION BOX:Z(ifresent 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 solids carryover,any evidence of leakage into or out of box,etc.): 1 PUMP HAII9BER: (locale on site plan) Pumps i working order(yes or no): Alarms to working order(yes or no): Conug+nts(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 r Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Lovell' s Lane Mars tons MI-11s Owner: Victor Miller Date of inspection: ,�j 3 SOIL ABSORPTION SYSTEM(SAS): t (locate on site plan,excavation'not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): �- C, 4 `ti d'— Goa ;l� �J ' , 1? c�L 7, CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Numbe and configuration: Depth A01 op of liquid to inlet invert: Depth solids layer: Depth oflIscum layer: Dimensi6ns of cesspool: Material of construction: lndicatio i of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Mated Is of construction: Dime sions: Dept of solids: Cor4nents(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Loyel l' s Lane Marstons Mills Owner: Victor Miller Date of Inspection: ° 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. 1 J iL q �W 10 I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 88 Lovel l' s Lane ars ons M1119 Owner. victor i er Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 3 Meet Please indicate(check)all method's 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 o-1 Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: i b /3 d m J► ,� 11 TOWN OF BARNSTABLE LOCATION 88LOVELLS LANE SEWAGE# 95-= VILLAGE MM ASSESSOR'S MAP&LOT® -0 INSTALLER'S NAME&PHONE•NO. ELLIS BROTHERS CONST. CO 352-6237 v SEPTIC TANK CAPACITY 1-5-60 LEACHING FACILITY: (type) 4 RiTS (size) 100Q s4L NO.OF BEDROOMS BUILDER OR Ov,YIY����EryR� VICTOR MILLER PERMITDATE: e? COMPLIANCE DATE: `2 _ 01 -7 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 1. # Y M 1 F' Y C6 nr vv k V1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphration for Di-t-ipwittl Work.6 C omitrurtion runtit Application is hereby made for a Permit to Construct (- ) or RepairXkXX) an Individual Sewage Disposal System at: .............. ...Lar e_..Marstan..9...Mill�q --------------------------------------...----------------------------------•---------------------- Location-Address or Lot No. Vic ------•- Installer Address UType of Building Size Lot............................Sq. feet DwellinjX-XNo. of Bedrooms................4--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—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. Seepage Pit No.----.:_ . _----.-_ Diameter-------------------- Depth below inlet.................... Total leaching area...._........_....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.-.---______---_-- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--..-_-_-_--__----__._. 9 ----------------------------------------------------------------------------•-•-•-----------.....---......................................................... 0 Description of Soil........................................................................................................................................................................ xD Sand & Gravel -------------------------------•-•-•-------•-••-------- v W UNature of Repairs or Alterations—Answer when applicable.Omit Cesspols.--_Install----1---1 500_._._.____.. gallon tank, 1 —distribution box and 2. 1000 gallon leach pits 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 y p by th bo of health. system o tion until a rti fate Hance has b en 'sued g 3/3v.95 Application.Approved By -- --- -- ----- ------- --------- ---------- ----- --- &---.... ... ---- - ----�—- - --. .......... ....---_..----Dace---------------- Application Disapproved for the following rear nS. ------------------------------------------ ............................... .......--- ...... .. ... ....-----—...................-------------...------------------------------............- -------�-Dare.........-------- Permit No. Z� .... .... Issued .............� �..,J Dare TOWN OF BARNSTABLE LOCATION 88LOVELLS LANE SEWAGE # VILLAGE MM ASSESSOR'S MAP& LOT D -O INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS. CONST: CO 362-64. 37 SEPTIC TANK CAPACITY 1560 LEACHING FACILITY: (type) .1 1�6 fJiTS (size)10= W/ i NO.OF BEDROOMS BUILDER OR OVYNE,jt� !'ICTOR MILLER PERMITDATE: 3/10X COMPLIANCE DATE: �_� 517 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 j b, t �z ♦ i i No..-- ...... J FEa..... ....3 0..�... THE COMMONWEALTH OF'MASSACH;U;,SETTS ' BOARD O' EALTH TOWN OF BARNSTABLE Appliration for Dig t1utt1 Workii Towitrur#ion Famit Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at: .............H--- ?aS?I�E'11 s----�J 4'. M t s to7n s Ni ...... ------•-------••----...--".........................................••------•--•. Location-Address or Lot No. MictoZ Miller.•._____ �W CGZ .3 5_0 �� O� G�i►/� (i`� %SS /'f-�,j /4 J, ............... .......:......... _: .a...........I.........._-__._...._.._._.. ......... _._................_ .._...._....___....._............................. Installer Address 94 vType of Building Size Lot............................Sq. feet DwellinK,=KNo. of Bedrooms----------------A__--------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons........................---. Showers ( ) — Cafeteria ( ) dOther 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 ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit----------------.... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch ,Depth of Test Pit.................... Depth to ground water........................ 1:+4 --------------------------------------------------------------------------------•-------------....---------------- •-----... --------------- ._...-------------- 0 Description of Soil------•-"----------------------......•---------------- ------ .....-.--------------------------------------------------------------------------------------•--- •_._. 4 D Sand & Gravel V ..-••••-•--•--•------•-•--•------•-----""-"--•-"-----•------•-•--"-------•--••-•--"•-"""-"----"•-•------•-•----•...---------•---•------•"----•-----•-----•-"-------••---••-------------•---"--"-""•-"••- W U Nature of Repairs or Alterations—Answer when applicable.-Omit ce S s po l s. Install 1 -1 5 0 0 gallon tank, l-distribution box and _2 1000 ga i-Jllon leach pits - 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 o tion until a rtif care Vig pliance has b •en,'ssued by the boa d of health. _ Date Application,Approved BY / - ...------------------------- - Y ...----- -------- - _•.f...... Y ......f..../:.... ...V ................Date..-.............. Application Disapproved for the following rear n.r- ----------------- 777777--------------------------------------------- -------------------------------- ..... ........................ -- --- ------- ----------------------------- Date PermitNo. .......1--- ----------------------------- -------------------- Issued ----------- / �..�/... ...... /Date THE COMMONWEALTH OF MASSACHUSETTS .� BOARD OF HEALTH TOWN OF BARNSTABLE 'M.We fte #E �f C'Tumplianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) byJ Di---- r�rnh® L!/!� /LO s �.(,iv S"71, GD ------------------------------------..._--------------------------------------- If,01er at .........8 8....Love l l s-_La.ne...r<Ia rston s----i 1 1-S------------------------------------------------------------------------------- ------------------------------ has been installed in accordance with the.provisions of TITLE of he tateY ironmental Code as described in the application for Disposal Works Construction Permit No. ............. . dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------- -f.._ ..' ... _ ----- Inspector - .... ? --------------------------------------- _ ——— `———— —__—.. THE COMMONWEALTH OF MASSACHUSETTS— BOARD OF HEALTH TOWN OF BARNSTABLE No. FEE.$...3 0..0 0... �tu�ruu�tl Turku �ua��tr�r#uan �rrntit Permissionis hereby granted--------- t.. ..........-c-...................................................................................... to Construct ( ) or Rpepair)(XX) an Individual Sewage Disposal System at NO. S Lovel1s L.a.ne...MdrStons_ M h=s--------... - '....n-- --1....................-........ -�....� Street Ei as shown on the applicati n for Disposal Works Construction Permit No...q �-_---— tedA� --� -- _..' / -- ----------- Boar =( ` d� Health ' !! DATE.................... - --------._.....-----------...... V I FORM 36508 HOBBS&WARREN.INC..PUBLISHERS isco LOCATION. SEWN l E PERMIT NO. VILLAGE INSTA LLER'S NAME R ADDRESS OR OWNER DA T E PERMIT ISSV E O -� J DAT E COMPLIANCE ISSUED I 1 I l 'No. l'a bS� FEID,�.�� s` ...._. ..----- _............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..............................O F.-.-.......-..-....--.-....------.......----------------.-.-................-.....-....---- Apotiration for DiupuuFal Works Tonstrnrtiun 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair Jean Individual Sewage Disposal System at: , p��� Loc o d ss �/ or Lot No. i��tFy n ... Addr a .... .... ... fir.......,.. ..............l ............................................................... Installer Address Q ®� Type of Building Size Lot_ ......Sq. feet U Dwelling/--go.o. of Bedrooms__ __________________________Ex Expansion Attic Garbage Grinder ►� g P ( ) g ( ) pa, 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'ca,pacity............gallons Length................ Width................ Diameter------__-_--_- Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of U -----------------•-•-._....._......._..-••--••-••--•..._•---------------------------------....--•-•-.....•-•---•--------•-•-•-••-------•------------••---••- -----•--------------------------------------------------------------------------------------••-••--•---••--•--•-----j--`-�--------------------------------•-------------------- .................. U Nat of Repairs orLte.raions—u�we hen applicable..dwezoE..�.."` ----------------- ----- -•---- ---------•-•---------------------------._....-----•-------------•--...••--•-•---•-••-••--.._..-•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT E 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 oj health. Sig n DXe Application Approved B ------------------•-----------•---••-----...--•-••---------------•------------- � Date Application Disappr e o e following reasons:.------••-----------------------------------•----------•-----------------------•----.....--•----•••••--•--..--- --------------------------••••---•-•---------•-------------------•--.....••-•-•-•••-------------..........•------------•••••••---••••••-••-••----•••----•••------••------•--•--------•••---•-••-••------- Date PermitNo.. ._":.2-.-°-........•----------------------------- Issued....................................................... Date Fimx.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..:........................................................................................ Appliration for.,Disposal Works Tonstrurtion Vautit Application is hereby made for a Eprrmt to Con4ruct or Repair (Z-1"an Individual Sewage Disposal S15i .... .. . . ...... ......................... .................................................................................................. ,Maw-urt.-L j or Lot No. ...... . .... . ....... ...... ... ........................................ -6. ......... Installer er Address Type of Build jtw..' Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow.......................................7....gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width_-_............. Diameter--.---._--__--. Depth................ Disposal Trench—No. .................... Width.................... Total Length......_............_ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet........._......_... Total leaching area..................sq. f t. 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.-_-.._.._........._.--_ f� Test Pie,.No. 2.... n -tes per inch Depth of Test Pit..-__-.._...__..._.. Depth to ground water............._......___. --------------------------------------------------------------------------------------------------------------------------------------------------- 0 Description of Soil................................................................................................................................................... .................. W .I............................... ...................................................................................................................;..................................................... U ............. -------------------------------- ........................................................ ---fx, ---------- ---------------------- U ti plicable----------------- .................................. lv�f ra Obiu�- _V---------------------------------- ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T T12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has issued th boa health. Signe.,... ...........................I........................................................ .......... -------- Appl ication Approved By. .. .......................................................................................... - ----------------- ...... 'Dat-e­*---------- Application Disappro e following reasons:................................................................................................................ 6e�®r ..........................................................................................................................................................................................I............... Date Permit No.J(Z-2.4 40,............................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDg:F, HEAr �.�-t.�tq OF................................ ............................................ Tatifiratr of Tompliana T 11 ",, 0 R T W%F That the Individual Sewage Disposal System constructed or Repaired '44 ....... ... .. ..... .............................................................................................................................................. b ji , I " ff- _­ Installer at........-.#ZAPL., Lc A 2Z f*4-------:..................................................................................................................................... . ..... ..- has been installed in accordance with the provisions of T4=, Tlie State Sanitary r y Code as described in the application for Disposal Works Construction Permit No.._ $............... dated__.._._-_-.-_----_-_..._................._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY. DATE........................................ ................ Inspector.... .......................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR7)OF HE T --4 F .... ............. .. ................................................. No . .....................0 ......................... FEE......11.............. Disposal IV pr n � Tons ��s trudion rutit ...................... ..... ............Permission is hereby granted.....�1 a�. to Construe or R it Individual Sewage Disposal System atNo.---- ...... &........ot................................................................................ ----------- Street as shown on the application for Disposal Works Construction Permit No­?!'...__�....4.1(.- Dated... ........... ........................................................................................................ Board of Health DATE...---•-•---------•........................................................... FORM 1255 HOBBS &'WARREN. INC., PUBLISHERS fit �t,0a,2 av n, e& I OuE e !15 H->WW O /O x 9 N Y�oo - O:H i r R a6 tX07- al -XIV FcooP �yolSrj 49,/(o" } Cf}NT. 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