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Home My WebLink About0010 VIOLA LANE - Health 10 Viola Lane , Marstons ._ A=043-006-009 Mills l TOWN OF BARNSTABLE LOCATIONA Q � SEWAGE# VTLLAGE r`c\jen.,��, s q;\\SASSESSOR'S MAP&PARCEL �L� c�Gv I MAI�IE&PHONE NO.��.�52„� SEPTIC TANK CAPACITY LEACHING FACILITY: ! ,O (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4> 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 d),,� A ( = .J A w r Commonwealth of Massachusetts 043-006P- 001 / Title 5 Official Inspection Form ®� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a M 10 Viola Lane i y Property Address { Denise Ciochini r... Owner Owner's Name --- — information is � required for every Marstons Mills . MA 02648 May 4, 2018 n _ C w" page. Ity own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information a filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T Sullivan _ kuse ethe return y. Name of Inspector Ready Rooter Excavtin rb Company Name — PO Box 89 Company Address r Forestdale MA 02644 City/Town State Zip Code 508-888-6055 SI 12843 Telephone Number License Number 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 _ May 8, 2018 Inspector's Signature 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 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. t5ins.doc-rev.6l16 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Viola Lane _ Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 required for eve May 4, 2018 q 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 to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 year old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration r exfiltration or tank failure is imminent. System will pass inspection if the existing tank is repla d with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass i pection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the ank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4 2018 required for every Y page. Citylfown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with ap/eveled rd of Health): ❑ broken pipe(s)are ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is rem ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box i placed ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required y the Board of Health: ❑ Conditions exist which require rther evaluation by the Board of Health in order to determine if the system is failing to prote public health, safety or the environment. 1. System will pass un ss Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health, safety and the envir nment: ❑ 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 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every _y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) .2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning y u ctionin in a manner that protects the public health g P P , 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 t e SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and t e 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 alysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent an he presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that o other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: ._ Yes No ❑ ® 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 1/z day flow t5ins.doc•rev.6l16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name — information is required for every Marstons Mills MA 02648 May 4, 2018 page. Citylrown 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- 10,000g pd. ❑ ® 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. For large systems, you must indicate either"ye ' or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is wit in 400 feet of a surface drinking water supply ❑ ❑ the system is ithin 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system i located in a nitrogen sensitive area (Interim Wellhead Protection Area—I A) or a mapped Zone II of a public water supply well If you have answered "yes"t any question in Section E the system is considered a significant threat, or answered "yes" in Secti D above the large system has failed. The owner or operator of any large system considered a sign' icant threat under Section E or failed under Section D shall upgrade the system in accordance w' h 310 CMR 15.304. The system owner should contact the appropriate regional office of the De artment. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..'' 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Y ,Marstons Mills MA 02648 May 4 2018 required for every 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): 3 Number of bedrooms (actual): 4 - DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 459 GPD t5ins.doc•rev.6/16 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is required for every Marstons Mills MA 02648 May 4, 2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2016= 205 GPD 2017= 175 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on/en 2 3): Gallons per day(gpd) Basis of design flow (ssq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holdint? ❑ Yes ❑ No Non-sanitary waste die Title 5 system? ❑ Yes ❑ No Water meter readings, t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts fig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every y page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owners records: Pumped 5+-years ago _ Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: Type of System: ® . Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool, ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is y Marstons Mills MA 02648 May 4 2018 required for every � _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank and leach pit original, 1990. Leach field added 08/06/1997. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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): 1.5 _ Depth below grade: 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 4.5' x 5' 1000 gallons 9„ Sludge depth: t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4 2018 required for every y � _ page. Cityrrown 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 26 Scum thickness 16" 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 -2 - How were dimensions determined? Dip tube and tape measure. 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 tee and outlet concrete baffle in place. Liquid level at outlet invert. Riser brings inlet cover just under patio blocks. Outlet under arbor legs. Arbor to be removed and tank pumped and cleaned by Ready Rooter Excavating. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions.- Scum thickness Distance from top o/scum utlet tee or baffle Distance from bottoom of outlet tee or baffle -- Date of last pumpin Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Y ,Marstons Mills MA 02648 May 4 2018 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 of inspection) (locate on site plan): Depth below grade: - Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: - gallons Design Flow: - gallons per day Alarm present: 7 ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Viola Lane Property Address -- Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every y page. City/Town 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 solids carryover, any evidence of leakage into or out of box, etc.): Leach pit acting as d-box. Pump Chamber(locate on site plan)* Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note conditio of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every y- page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-6'x6' w stone ® leaching chambers number: 6 Hi Cap w/stone ❑ 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.): Liquid level in leach pit 1' below outlet invert to leach chambers. Staining shows pit has been at outlet invert level. Outlet tee to chambers under lid of pit and not accessible. No inspection port in chambers. Nand probing over chambers found clean dry stone. No sign of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet/ow. Depth of solids layer -- Depth of scum layer Dimensions of cesspool Materials of construction — Indication of groundwater in ❑ Yes ❑ No t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'' 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every _ Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.).- Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of/signsulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every y page. Citylrown 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 - 3 � t5ins.doc-rev.6116 Title 5 ofriaial Inspection Form:Subsurface Sewape Disposal System-Page 15 of W Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every Y page. City/Town 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: >5 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: 10/27/89 Date ❑ 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) ® Accessed USGS database-explain: maps.massgis.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole for pit found no ground water at 10' (elv=69) in 1989. Base of leach chambers 5' below grade. Accessed local ground water contours and topo mapping. no high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 10 Viola Lane Property Address Denise Ciochini Owner Owner's Name information is Marstons Mills MA 02648 May 4, 2018 required for every y page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 „I •._.-a._. .__-1._I tl ,' �I 1 �-r.� I� -:. I I - I, -- i f I , hill/��i • 8 : I . bC : I h, : I � _ , F N i � NCHA�`U { r i. Vr) 87 TOWN OF BARNSTABLE 1 LOCATION D \Jck(�� SEWAGE # VII.�.AGE ,M��1�``� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � ✓ IJ� S SEPTIC TANK CAPACITY `S -- WOa U&ILL. v LEACHING FACILITY: (type) °��Lit)C►SC �`(-- (size) //X 34yor NO. OF BEDROOMS BUILDER OR OWNER `k a o PERMIT DATE: 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 l � / � 3 �' 2- � o �� ®j 'd � I �� . ,� �� i �; - t,., MASSACHUSETTS IV No. �� Fee THE COMMONWEALTH OF MASSACHU Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB 2pp[ication for Mi5 o Y *p.5tem Conotruction Vermit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. U ZC)� l.�u�� Owner's Name,Address and Tel.No. Assessor's Map/P c 00 �+ r In r's Name,Addass,and �Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms J Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _7;_1 C) gallons per day. Calculated daily flow L115,1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank #S,y \070 Type of S.A.S. c l Description of Soil ' SAVO Nature of Repairs or Alterations(Answer when applicable) � `SlyS�r� l Cc. C CAj t wC, fl"J �� may► �� .� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of th Environmental Code nd not to place the system in operation until a Certifi- cate of Compliance has bee i _ Signe Date Application Approved by - Date Application Disapproved for the following reasons Permit No: Date Issued too* No. "' 9Q Fee 0 THE COMMONWEALTH OF MASSACHU E S Entered in computer: Yes t PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB MASSACHUSETTS ZIPPfication for Oi� o f *p5tem Construction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. BUJ Owner's Name,Address and Tel.No. Assessor's Map/P c , 0 O I is/N^arne,Ad s %ndd Tel.No. Designer's Name,Address and Tel.No. 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 '7 s� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 'yzc rS) k Type of S.A.S. kA e,c Description of Soil 1= 0 Nature of Repairs or Alterations(Answer when applicable) �'�`S� �k\ y( f'�t S-1 S,r She 6'l kA. ,L�N CG �C r-(�''1 1 a`../_EL.T✓c"."\LY I S U-r J�"f f STG `r' �►A..t'�-� � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of; Environmental Code nd not to place the system in operation until a Certifi- cate of Compliance has been i d-of HeiR p _ Signed Date 0 -S"7-7 Application Approved by Date Application Disapproved for the following reasons Permit No. " Date Issued ' ——————— ——————————————————— —————— —THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER��the On-site_Sgwage Disposal System Constructed( ) Repaired ( ")-Upgraded(t/< Abandoned( )by at b vl v l_C V P, `k co_s has been construe ed in rdannccee ., with the provisions of Title 5 and the for Disposal System Construction Permit No. -7ated '�' `J'" / Installer r Designer o The issuance of this e i 11 0 l p4onstrued as a guarantee that the s stte will function as desi ed. 1 ! Date p g InspectorV l� XI iP71 U No. --------------------------Fee `✓ '�'"�� THE COMMONWEALTH,OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 0i.5pozat *potem Construction Permit Permission is hereby granted to Construct( )Repair�(!/�pgrade•( )Abandon System located at /0 V i y f c L-Q_- A YI"1 -S 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 conditions. Provided:Construction e completed within three years of the date of thismait. Date: e Approved b r NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated 7 , concerning the property located at 0 0N.&& meets all of the r following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. II' SIGNED : DATE: LICENSED SEPTIC 9YSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER" [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. v� E r l TOWN OF BARNSTABLE LOCATION 0, \J,k y``'— SEWAGE # VILLAGE M� �� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY v , LEACHING FACIL=: (type) 1' ��n CN 4�c�t-� �:1- (size) ��X g NO.OF BEDROOMS � a BUILDER OR OWNER PERMITDATE: 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 r� Q 0 0 711 i op A/ 4LA f. ` Sr5 4- , gr� ZD4%tom✓aO�/ //O X 3 - 3 6.Pam. ' .� �� sy--ic i7S 5.=x 2.5 = qy cz..Pa_ : AI gym. -yV 4A?,,=4x AD -77 P 72!)74z- DESiw TbT.1� D4-1-Lj/.cGow = • 330 e-.P.p. Pic P4r� = /in/.. Z Mi.✓. �2�L�� j DFk Of 3 STEP iE g ��,$ ? ALLYNN gam♦ Awic. ARD y ., .. L. oo WILSON �BAXTER 5 i No.30216� N9.24048 m �fClS1EPETJ ORA 1 L, 1 �-Es,-srcr� R704 , S-Zy-ss I/A�5r4l A><Ma t. 14Jgtor5i-EAle, L./p•C.C.,21s&s wry sot/-�/�. Gti,�.sii.✓�- B.o ff. c��r�i„/ z,� Ir83o i,., Ta�fHo� By,o 1 Aw B0. t S i3x/L LoA+�'/ D/sr; Awo / ; 5 sir ° 5 35� ' i' C! . . , /,v✓ G.4L, /.vu � ' ;.. BOX .�.2• .�.� I Ju — rrw , sip .e477,=/E45)oo PGOT l�t:v�t/ I SRO 5�/p '` A,�v✓O .b ,_73,b ., q ' _ Loc,GT�osi M�Sr�,.✓s /�'lit,c s I Io4au;A4,4rs og yyg �6. 8 7;V,4r'Th/�' Fo �oana/S,yaw.v / / - 7 ,d,S/.D,fE'T,(�jJGY_ .Q�4V/�'ENl�itfrS d� Th'� .2.E6'isrz�.ec'.O�-.ec�o.Sli,2✓Eyo,Ps � Toas�,v oF�•4�2�/S�Bl.E' �Nl� /S ,vOT G�ST�.Gli/LL,c a-• ,sr-�.� ftz -- ._ ..t/.y�Hr-.Sv,2vEY.�ivO T,sr�o�F..S•�r..� _ Sh�tyv yE.2�Giv s.�ovGD NoT� USEp - --------- - - --- Ch Cad 2 . coy D Ali l� � TO �Cti.^. 4'{C:. ..'.RAn-.K•'d�11�.P4ssiF. .G Y I'Al x 4-0B s � 0 � ° ' �n lei 0.1 X ��#, � Ted . N o ►c � , �� 1� c 1 .�� er,- . x d � p1 e a o a a Z 1 `Y ^W4(�� L- 6j ter F ! Po f-�y ij t p ' yRg U H { I UD�yj TOWN OF BARNSTABLE LOCATION /,0 VIO,C,y .LAIC SEWAGE # ,c? VILLAG ASSESSOR'S MAP & LOT S INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY / oo 0 LEACHING FACILITY:(type) Pi z" (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTE D: Yes No (... ' _ i V �G� Z� ` I �®�s� �--= �° Zg � 3 <3� �.3 "�'`� �a `--�.�. �•��— +yam. No... �9�C�.. y Fps.... ............ THE COMMONWEALTH OF MASSACHUSETTS _ n BOAR® OF HEALTH %Oc3rslt...................OF....... �t<'r/Sfa 4614C Appliratiaan for 0hipa i al Warkii Tomitrnrtiaan Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ® eloe 4 e �u .. !-,.5............................•-------------.......................-- Location-Address or Lot NO. ...............U_-QW1".x...sklalftl.................... 1.?r _..6e1-.01A..411...................... Owner Address W �rx 1�_... 1ff's.............................................. ,.� ----- ---- ------- •-•----------- . --------- -----•---•--- -•------•- Installer Address Type of Building Size Lot__f.43;.71.b......Sq. feet U Dwelling—No. of Bedrooms___1Ilt`c.--C...........................Expansion Attic WO) Garbage Grinder '4 Other—T e of Building No. of persons-•_--_______-•______________ Showers — Cafeteria a' Other fixtures _____________________ __ W Design Flow...................................�S.gallons per person per day. Total daily flow.............................. 30...gallons. WSeptic Tank—Liquid capacity_IDO.9.gallons Length.13..-f.°1... Width--%::Jli!".. Diameter......:........ x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..._.o_Xe------... Diameter.......1.®a-----__ Depth below inlet......(6 ......... Total leaching area..&C2....sq. ft. Z Other Distribution box (A) Dosing tank ( ) // rle a Percolation Test Results Performed by..... ..`1 y. .i......................................... Date...81�I •---------_-- 1.4 Test Pit No. 1....A........minutes per inch Depth of Test Pit......7.._........ Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa ;. 04 OF x Description of Soil _ � 1.Qy'� a ss?lJl_... --•--------------------------------------------•---•---------- ..�YEIi} Eiv �y U .................................... _-.5_.....CIA y---------------------------------------------------------------------------------- ----.- .......ALLYN........ .................................. r.....�ll�c ldl�7._._�5?!7 ----•------•---------------•-------...................----••......... aAIILSON U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------._...._...... ....................--------••-•••...--•-•-•---•••-------•-•-------------------------...........--•--••----------------•-••--•----•---•------•-•.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ith — h undersigned further a agrees not to the'f�•%the provisions of TITLE 5 of the State EnvironmentalCode Theg place, 07 system in operation until a Certificate of Compliance has een issued by the board�healt �.J _�Signed - ...-_ ,..... . ---..... . l.. Application Approved By ------....--. ...- -.-............... to Application Disapproved for the following reasons: ... ...... .. ........ ................. .... .................................................... ......... --------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------------------------- ---------------------------------------- Dare PermitNo. ..........�fl......1 -S7.165......................... Issued ..---.------ .---------------.......--------........--------.. Date No.... ?:�p 5d.. FEs...... ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --..../a �-!�..................0 F.............�...r... `...��c--------......................---•-•-•-•-•---....... Appliratinn for Disposal Works Tonstrnrtiun rruti# Application is hereby made.for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: Location_Address or Lot No. .......................:..........sv . /hi..................... Owner � �T 54 Ad ress .................. ... ! /,a- -515.............................................. -------------- Installer Address QType of Building Size Lot...Lki-2•-a.....Sq. feet U Dwelling—No. of Bedrooms._l.v-' r:...........................Expansion Attic (lido) Garbage Grinder A) Other—T e of Building No. of persons............................ Showers — Cafeteria QIOther fixtures -----•-•----•---••-------------•--.............................. W Design Flow....................................6 a,gallons per person per day. Total daily flow.......,.._................ .. .3.0...gallons. 04 Septic Tank—Liquid capacity.106. .gallons Len&th..k"!6!`,.. Width.A (6_t" Diameter....... ----- x Disposal Trench—No. .................... Width....`.............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... rt--------.. Diameter.......I.o........ Depth below inlet......4............ Total leaching area.AZ....7....sq. ft. Z Other Distribution box (A) Dosing tank_( ) Percolation Test Results Performed by..... _a__. �. .......................................... Date...S/Z4AY.........._.. 1.4 Test Pit No. I___- ........minutes per inch Depth of Test Pit------9.1 ......... Depth Depth to ground water_. ...... Test Pit No. 2................minutes per inch Depth of Test Pit..................,. Depth to ground w -OF O -•••--••..... .............••-•-•............•........, ..........-........................ .............. TEPHEN Description of Sort f�' �.cx°e •-� t I...... -------•••••• ?! N...... ..•-•--•••••--••••--••-••---•••••-•� ...... .luti •--•-•--•-•--••••••-• •-----•••••••••-----•-•-••-••-•-•-•-•••-••••-•-•-••---......•-••••......------ x ALLYN U ��" 1 , �NtCS011t UNature of Repairs or Alterations—Answer when applicable............................................................... ...............................-..............................................................................................t...=........................................ � Agreement: F/N The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in cordance with ervie. the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the"for' PP system in operation until a Certificate of Compliance has.(peen issued by the board of health. Signed ........ ..-. ... ...-..... . ... = Date.-.. Application Approved By ------------- `.. ...;� ... ............................................................. ------ •� to Application Disapproved for the following reasons: ....................................... . ............... . ...................................... ............. .. ...... --------------------------------------------------------------------------------- - ----------------------------------------------------------- ------------------------------------------------ ---------------------------------------- Date Permit No. `. -- -----�.--t.......(tt...�-�5............................ Issued ...................------------...------ ---- --...---------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `` ............... OF ................: 'i .. , .. ✓:4'�. ----------------- C�ex#tftctt#P of Q11-0rapliane THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 11) or Repaired ( ) b M Installer + P ... has been installed in accordance with the provisiori!of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ........F" -'r'-64 ............. dated.......................----...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------- ------------- .....-----------•--------------------------- Inspector ------......-----------.....------.--- ------•---------....... -- ........-- -- -- -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH ....... ....�-'�,� ✓.............OF.---• --o 11 T'F 7" 4 _ ,e .•••................. No...... :�. � FEE... --------------- Disposal arks Tonstr ' Yt rrmit Permission is hereby granted..•...... :: _.__ . �' ---.------• ``" t� 't" ,-°`� to Construct (�-�'or Rgair ( ) a ndividual Sewage Disposal stem at N o.ems?.!' Street as shown on the application for Disposal Works Construction Permit No2?-4?.6_P Dated.......................................... .................................... ................................................. / (�/ Board of Health DATE.......................... / -7.' -.-•------ -------•- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS / r l� i 7,4 /3,790 �1 �.� D/5�'S.t�L. sio�w.d"— •d,P 170 s' �, w IQ p X AD = _.. c�� a Tbnk Z)41� Rota/ - • 330 e..P.p- ,. of :.v"I OF .. web STEPHENALLYN � O�� i � , !- 10 o • j WILSON y ca - R Na.30216* No.24048 Q crsWkONA � y14✓440,6;-E,41�. /.�T4u- ��.�. I wjGsoit/-6✓6, G1'J�l/s//✓!�: &.0�_ To;Wiry�in/ �3 O /�`y, 3 UG.d r �•+'�. � 8�� ,1,'l TCCCafiYO, � ('D .V.e. Sir o 5u35w /44D oisr, /Ot''1'j /.vu �'- y 49 x /.v✓. 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