Loading...
HomeMy WebLinkAbout0279 OLDE HOMESTEAD DRIVE - Health 279 Olde Homestead 10(,�I Marstons Mills ` A= O43'00 027 i ,I ,I I No, C9,00 / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Zigooal bpgtem Conotruction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 2-7 9 Old Ho me,s+e4d 1X Owner's Name,Address and Tel.No. MQrS+ons / iIIiS AAA ,Tames �Jeley Assessor's Map/P3gt,3 cc/ 1 --79 Home51-eod Dr- M-tit t I i5 JU�1 . Installer's Name,Address,and Tel.No. bog—4*7 7—DG S3 Designer's Name,Address and Tel.No. f?Obef't �ilFoy Qt13 _,kCcivatton 14 Tecaberry Ln. 1' )( e-5+c ctie , MA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repai r Alterations(Answer when applicable) I Date last inspected: 8 �U 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 Certifi- cate of Compliance has en is ed s Board of Health. igned Date 9 2 o 5— Application Approved Date Application Disapproved for the following reasons Permit No. Date Issued No: (goo / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS J 2pprication for 30i5p0al *patent (Construction Permit - Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Z7 9 o I CI I l U me 5 t e a d Dr Owner's Name,Address and Tel.No. Assessor's Map/Parc 1 M n r51 U s 1 S /�I I 151 AAA 2 c i m e 6 \I e_I fe\I Y c� 3 CEO/ ' 7 79 I-lvfYte-SFcnc► D` MAMs MA . Installer's Name,Address,and Tel.No.5 U,S - 'I'17 U(,j 3 Designer's Name,Address and Tel.No. - RUberl GiIrol f�I kLtivc�i1G,n ICI Tenberrj Ln, FOre5icicde , MA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) ~= - Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date r , Title Size of Septic Tank Type of S.A.S. _ Description of Soil Nature of Repai or Alterations(Answer when applicable) I ) r - Date last inspected: (J -.-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 Certify= Cate of Compliance has been issue is Board of Health. Signed K , Date 9 z U Application Approved Date-" `7''Application Disapproved for the following reasons Permit No.r Qe, f 5 c`l Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS C" (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at 2-7 cl 1 In C 4:1 r A 1 has been constructed n accordance No.- with the provisions of Title 5 and the for Dis osaI S stem Construction Permit No.�Oo S y 7� dated Installer 1<n bt r 1 (-�i I ft) Designer ,-- The issuance of this permit shall not be construed as a guarantee that the system fwill'function;s designed. Date 0�1') Inspector - --------------------- ------- -- --- --_. _ -- --- No. C0 Z - Fee V U THE COMMONWEALTH OF MASSACHUSETTS �j04 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopo.5a[ *pgtem (Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) ,System located at Z19 01.f7 +F' n C' T7r._NI n t 5 i n rt S Ail (S MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conn�iti ns. Provided:Constructi n must a completed within three years of the`date of this pe 't. 6l Date:_, C7 3 Approved by TOWN OF BARNSrTABLE LOCATION o�`> Q 0X)�'6 AOmel5i SEWAGE # VILLAGE {'�Ar U S rn� '��-s ASSESSOR'S MAP & LOT (VI�0077 p_ t�c�>`r.e/ jtif. O'C'on1J ekA, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �, (size) NO.OF BEDROOMS OWNER MA'S Le PERMIT DATE: V(0MPLIfiLNCE DATE: a V5 Separation Distance Between the: �'�` Maximum Adjusted Groundwater Table the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION OA4 9�0v TITLE 5 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT96 SUBSURFACE SEWAGE DISPOSAL SYSTEM FORMc' PART A � co CERTIFICATION Property Address: 279 Old Homestead Drive o Marstons Mills MA 02648 Owner's Name: James Veley Owner's Address: Same Date of Inspection: August 8,2005 Job#05-242 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 training and experience in the proper function and maintenance of on site sewage disposal systems. I ar�9 F f*, approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system�J� • .••""•• `. Passes ATRI •:cGn _X Conditionally Passes a cn'i r Needs Further Evaluation by the Local Approving Authority ELL :rn • *: Fails �i T �F`�Q.•Q``�� Inspector's Signature Date: August 8, 2005 INSPEG ���` 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. Notes and Comments: Distribution box is decayed and needs to be replaced; septic tank has solids carrying to d-box and needs to be pumped. Leaching pit has 30" effective leaching. ****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 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 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: XX Distribution box needs to be replaced, box is decayed and not structurally sound. One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title C Ino—otinn 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for 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: T41. C Incnontinn 17— 411 c»nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. Tiflo G T.C—f;— T7— An c1101)n 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant, or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X _ 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 _X_ _ Existing information. For example, a plan at the Board of Health. _X_ _ 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)] T;t1A C Incn—t;— Rnrm 411 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): unknown Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003-77,000 gal. 2004—94,000 gal.=234 gpd Sump pump(yes or no): No Last date of occupancy: Five days prior to inspection. COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: - Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date: 10/10/86 Were sewage odors detected when arriving at the site(yes or no): No Titla G Incnartinn Fnrm 411 ci')nnn 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 16" Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: - Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 8" Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5' long x 5.2' wide— 1000 gal. Sludge depth: 9" Distance from top of sludge to bottom of outlet tee or baffle: 21" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 7" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Baffles intact,solids inside baffle.Tank needs to be pumped. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction: _concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Titles ; 1ncnnrtinn Vn Ail';I'MM 7 f 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: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" -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.): Liquid level at bottom of outlet pipe box is decayed and needs to be replaced. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): T;*1A 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit 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.): High stain lines in pit indicate 30"of effective leaching. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Title G 1ncnortinn Rnrm All cnnnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 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. Old Homestead Drive #279 Garage 15 26 43 34 29 34 Tifla C tncnPPf;nn Fnrm 4/1 V1000 10 i Page i l of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 279 Old Homestead Drive Marstons Mills MA 02648 Owner: James Veley Date of Inspection: August 8,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.50 and topo map shows property at el.80. TitIP f Incn Pt;^. F: rm 411 cnnnn I 1 Vr Septic Inspection Services Co. PATRICK M. O'CONNELL a 189 Cammett Rd Marstons Mills MA 02648 508-428-1779 E-mail Title5sis@aol.com To: James Veley 279 Old Homestead Drive Marstons Mills MA 02648 �� -77 73 Date of inspection: August 8, 2005 Job # 05-242 Inspection: $ 225.00 Locating / Labor Hrs.@ $45/hr $ 0.00 Expose covers: Ft.@ $30/Ft. $ 0.00 Total amount due: $ 225.00 + Filing Fee Check#(SIS) Check#(TOB) $25.00 Please make checks payable to: SEPTIC INSPECTION SERVICES CO. Town of Barnstable residents need a separate check payable a able to: TOWN OF BARNSTABLE in the amount of $25.00 for a filing fee. This will also serve as a receipt that your report has been filed. satisfactory condition. x Date: �� 7— 0 5s Thank you for your business. Feel free to call if you have any questions. Patrick and Kathy O'Connell. t'3 LJ J Li9 � CO J CD Ali. L. Cr G 7t. C5� QV C-a ` $N Od � ; �OWN OF BARNSTABLE � - f3 LOCATION oC yr VILLAGE T 'i r5 dd'l �' S ASSESSORS MAP & LOT INSTALLER'S NAME & PHONE NO. yS �, .�t,�Sl��� `��I 5417 SEPTIC TANK CAPACITY }066 �, J i LEACIHNG FACILITY:(type) LCe,6� }, (size) 1,Orb 4 4 d S- NO. OF BEDROOMS _PRIVATE WELL O PUBI�WATER v } ( BUILDER OR OWNERS DATE PERMIT ISSUED: 0 j �� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ^� i �� � - �. � � �J , �, �� i5� �� ..._- ASSESSORS MAP NO: P-44t, li -2 PARCEL NO.: THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH ..........rn.v.,r.L...............OF.........&aArua-f a,.6-4--------------------------------------- Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct ()0) or Repair an Individual Sewage Disposal System at: 4001...I la.....O]Jz..Pmruat&id....D.4L'iH. .. ...... A�. ..... ke.. .............................................. Location-Address _& er t N.. .....RIC I.W....4M ................................................. .............................................. Owner Address .................................................. -----& ..fA.M......... ............................................... Installer Address U Type of Building Size Lot.....11,,all------Sq. feet Dwelling—No. of Bedrooms........ ...8_19P..................Expansion Attic Garbage Grinder ( P4 Other—Type of Building ............................ No. of persons......_...._._.......__.___. Showers Cafeteria ( Otherfixtures ...................................................................................................................................................... Design Flow.......... 55..........................gallons per person per day. Total daily flow......._Y&A........................gullons. 04 Septic Tank—Liquid capacity.1.00D.gallons Length.....8........ Width.....&....... Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.......... . ......... Total leaching area....................sq. f t. Seepage Pit No-------I------------- Diameter......5........... Depth below inlet......4?......... Total leaching area..igaO....sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---LJM,_._tuzLAuxLk........................ Date.....!qI-IA ........... aTest Pit No. I.....s?.......minutesperinch Depth of Test Pit.................... Depth to ground water..___.____...........__. Test Pit No. 2................minutes per inch Depth of Test Pit..___........._..... Depth to ground water........._.............. ....................T...........................................................I........................................................................... 0 Description of Soil......... ...............-TO ...1.....4.u�&4_ZX&---------------------------------------------------_------------------ ......02.1.5-2----—-- ............... . . . ......ate?, , ............................................................................ --------------------- ...................................................... ----------------- - ------------------------7......................................................................... U Nature of Repairs or Alteration Answer en 'cable_____________ - ----- ---------------------------------------------------------------------- ................ . .... --------------------------- ------- ------------------------- - ----------------- --- ------------------------------------------------------------------------------ Agreement: The tindersiKeftees o stall afored ribe ndividual ewage Disposal System in accordance with MTM the provisions of L i I LE 5 e State anitary ode The der i d further agrees not to place the stem operation until a Certificate of Compliance has b i ed by of health. 7�% Sin . ............. .. ... ............... .............................. .... ........ . ............. Application Approved By________________________ .............. .............................. ......... ...................................... -- Date Application Disapproved for the following reasons:.............................................................................................................. .................I..................................................................... --------------­­------------------------------------------------------------------------------------ 'w_ �3 Date Permit No.._.5�. .. 3 Issued .... .......................................... Date ,y3- I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ( ....... ................OF........I.4✓..?.raz)_Y-.al'- 2._..._._. Appliro#ion for Disposal Works Tonstrn.rtion JIrrutit Application is hereby made for a Permit to Construct OC ) or Repair ( ) an Individual Sewage Disposal System at: ................................................ Location-Address t No. W Owner i e Address ----------••----------•--•... ............. . .( ..... "' Iasta:ier AdddreresSs UType of Building Size Lot...._ ,c. --------Sq. feet �-, Dwelling—No. of Bedrooms........3...8 s.F....................Expansion Attic ( ) Garbage Grinder ( ) PL, Other—Type of Building No. of persons............................ Showers — Cafeteria dQIOther fixtures ..-•-••- --------a---------------•--------------...---•--------......------------------......-•---.----......-------------••-----...•......---• .� -----••••.gallons. W Design Flow........:->.�............................ lions per person per day. Total dail/ gow.._...,.�3L.._....._....._. WSeptic Tank—Liquid capacity/_LC? ,O_.allons P Legth___R........ Width-_-12......... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit NO.___.1-------------- Diameter....5-_�--------- Depth below inlet..... ............ Total leaching area.a®_(:._....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by._L.M.......61�1_ ". xr.......................... Date----�)J-7.1-5.C__._•_._._.._.. Test Pit No. I....X........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-_.--•_____-_-_---______ ..................I......--••--•-•-•••-••---••••-•.......•----...---•-.........,.............._.._.._..._._..............--•••-...........................-- O Description of Soil © ToJ...` ----- ---------------------•-------------------------------------•--•---•--•----- U .----------------------------••-_. ..5...... - . ....._..... » ......5A4___\d...---------------•---•--.--------------------•------------------------------- �J W •--•------------------------------------------------- -----------------A.& _./.S p. ......................... -----•-------•-•------------•-•---•-•-----.......................... U Nature of Repairs or Alteratio Answer hen a icable____-_-_-.-- ------------------------•--_-----._-.-_----.---------_------._-----. ............................................ ...... .............. -- --Y ..---•-•----•---•-•- ••. •-----•----•-----------•••••--•-----•----•-•--•--••-••-•-••-......--.......-•-- Agreement:'_-`V :) y The undersigned agrees to install afore scrib Individua' Sewage Disposal System in accordancg the provisions of i?T i. 55 i ne State anitary od ' The nd s' ed further agrees not to place the ysoperation until a Certificate of Compliance has b n ' ued by h o of health. �� Application Approved By.......................•-. .. Date Application Disapproved for the following reasons:.............................................................................................................. Date Permit No.------.. -------- -•--- ----� Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........Tiu,..t .................OF....... r.�✓).�.O..l"i.h....................................... Trrfifiratr of Tontplionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ()0) or Repaired ( } by.......KAR-.,.A..._...f 14--L.. Installer at G ' �� ._._..__�t l t2_ �/t t r •-.-----------�..�L/ 1 "fi±`L ? -------------_------------- has been insmiled in accordance with the provisions of iIT E j of The State Sanitary Code as described in the application for Disposal Works Construction Permit .V a= -_:..-_-___ .: 1: ._..�_ d - =Y.��_�_.•.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ST _ AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... ...... �� [----------------------- Inspector............... . ....................................................... THE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..:.r3..................OF..... N...................... F EFL.................-•--- Disposal Works Twonstrnr#iou rrntit Permission is hereby granted......K_-A.'I:!.-•-- '. -_'......•--------st------ ---------------- ................................ to Construct ) or Repair ( r,) an Inddiividual Se ]�wage Disposal S stem at No..ho_�....'T.o....&.6id.....YZ �b_[_/S. ......i/.,2AA.4............. .......................... as shown on the application for Disposal Works Construction Permit 7'............... Date .._. C� Board of Health DATE.Q ....� f...1---1 g-r FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ca l►,A C/xt..E. Tik�'' vi%.("i 3 D�.ti�'.jbOM I O e �I,h V._1 �I F v.-Y 1 i. �E�t-�'A�u�1C ^�• . '330 .X:1 SO/o �q95 C�.t'J I . Ll ��15�05<!�l—�rT "� USL.: IOOC� �At..t._U►,J� �� 1��ZOIJ� ��� SULLIVAN No. 33 A. P .F- '1SO 5 F '°� aFc do E i t 5ds 2.5 �/g r • 375 1lk 50 _ CA�AL� 50 5 r� t.L>G./5+� - 50 C-c i�i ��,��• � , is WHARD BAXTER . o l�E516X K.A �I�I.AT1 Z� �1 '�" :'- F�, �1 2 t fJ C: (,p ew j�@ . SUB Iunij G� 1F'►�b' v-rfJ �000�a�P►'t' A-O'T o►•tz.s-► 1' ' I._OGAT10�--•t �I�1ZS�TDI.As MIL.L..$ SZDI�E:�3ct' M ' �G fvLiz AS m0Try Is)V9 6 +lam f`OMt=4T'YI�r. . . _ i. ; . ;. �� V✓M,WaiZwt�K SSoc,1 NC.^�Z.OPOS F�j G �1F\( 'n-L4T T+i Z 'F�cut 1 tr��tJ 5�10�c1t. `v'",►::,�: ,i•q,8s -- fl�=�•�>a c.oNt'l-`f5����i��'1�F 5f�>�.I.�;Iac�.a°f _ �3r. fv,�� �. tii��t_. I►��, I �, 1 th s'► t3lE �'� 1S N or LO L 4,-`C�i f►J� 1�f�'�....i UoT- -c3N�Gi• ,:�i.11�►.1 a ►✓sue►-.-�' SLl>���►�-1�Z�t=-s �^a,,� iOXiOTOT.FTE ;Nl,., i e r l_►it tt-zJ .,` �-' •.mac 1-7 \�-s1<�� 120 OF )41 oJp it o SUL l l d.rE{ 86 _.} } / SS/ pNA t w ` .' WHARD A. BAX Q`- { mS TER ` �._ Ito" Na24046 v' lot --- - . to o Y. , 01 1. A "S, _ --I a cull). : .1- 10 564'1 •ti_, tJ% ±O TO THE tal.H