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Home My WebLink About0063 WILLINGTON AVENUE - Health 63 Willing ton Ave Marstons Mills \(A=( � 103-040-002 XN tP a P a P L7 ' a d> Commonwealth of Massachusetts _ , .Title 5 official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every M_arstons Mills Ma 02648 8-29-13 page. City/Town 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. I Important:When filling out forms General Information on the computer, 641 , use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return Name of Inspector key. B&B Excavation, Inc. Company Name 14 Teaberry Lane _ Company Address ,Enm F_orestdale MA 02644 _ City/Town State Zip Code _(508)477-0653 S113640 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 8-29-13 _ Inspector's Signat a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and•thesystem owner shall submit the report to the appropriate regional office of the DES- Toe-oug fdM-h.6 ltl be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at ttte,time of.inspection and under the conditions of use at that time.This inspection does not address°1�ow the system i ilI perform in the future under the same or different conditions of use. �11T SN`V2 20 f tot W /osa�ySstec Ut5ins•3/13 Title 5 Official Inspection For ,, ace Sewage Di •Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. City,'Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 l Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Willington Ave. Property Address John & Donna Young Owner O Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. City/Town 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 approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to 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 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. I. 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 ve etaed h wetland or a salt marsh s t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is Marstons Mills Ma 02648 8-29-13 required for every _ 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 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 aseptic 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 '/2 day flow t5ins-3/13 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- 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® An portion of a cesspool or privy is within 5 Y p p p y 0 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 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 M 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as 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: J Number of bedrooms(design): 4 Number of bedrooms(actual): 4 — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 460 Gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: Number of current 4 e t residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): - Detail: i Sump pump? ❑ Yes ® No Last date of occupancy: current_ Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. City/Town State Zip Code Date of Inspection Do System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•3/13 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 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1'8"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20'feet -- Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good working order with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 112"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: 1000 Gallon Sludge depth: 2" l5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts -y Title 5 Official Inspection Form _ - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -- 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 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 33" Scum thickness 1" 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 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good working order with no evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ---- Distance from bottom of scum to bottom of outlet tee or baffle — Date of last pumping: Date t5ins•3/13 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 63 Willin ton Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date -- Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 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 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name information is Marstons Mills Ma 02648 8-29-13 required for every _ 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 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.): At time of inspection D-Box appeared to be in good condition with no evidence of carryover or leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I - - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Willington Ave. Property Address John_& Donna Young Owner Owner's Name information is Marstons Mills Ma 02648 8-29-13 required for every _ page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Type: ❑ leaching pits number: ® leaching chambers number: -7 Hi Cap Linfilt. - � ❑ 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.): At time of inspection leaching appeared to be in good condition with no sign of hydraulic failure. Leaching was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 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 63 Willin ton Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 page. Cityfrown State Zip Code Date of Inspection De 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 soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts -- Titl.05 Official Inspection Form J?jSubsurface-Sewage Disposal System Form --Not for Voluntary Assessments 63 Willington Ave. Property Address John&.Donna Young Owner Owner's Name information is required for every :Marston Mills Ma 02648 8-29-13 page. CityfTown State Zip Code Date of Inspection D. System Information (coat.) 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 A g Al- Az- A3- qC C3I Z Z -- 6Z 1-7 63 4V t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 L f Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 63 Willin tg on Ave. Property Address John & Donna Young Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-29-13 _— 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: no GW 126" 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: 11-4-03 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: You must describe how you established the high ground water elevation: Plan on file I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' M 63 Willington Ave. Property Address John & Donna Young Owner Owner's Name -- information is required for every Marstons Mills Ma 02648 8-29-13 page. City/Town 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 / TOWN OF BARNSTABLE L;)C A'IION C0 2 v � �G SEWAGE X c VILLAGE (k.,ASSESSOR'S MAP& LOT 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY SZ--i tlTVD 5ek � LEACHING FACILITY: (type) �"26:n&��Xoi tsize) 471 FGl>l r NO. OF BEDROOMS 14 BUILDER°OR OWNER t PERMIT DATE: e COMPLIANCE DATE: ��/ G 3 � � r Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I �- � c c Or /f a- No. ZCO J r S 3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for �Bigpool bpgtem Congtruction Permit Application for a Permit to Construct( )Repair Q4 Upgrade( )Abandon( ) ❑Complete System XIndividual Components Location Address or Lot Nolzwfllir11 0 Uv� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 10 �-0 qo/DOZ- Installer' re, ess,and Tel.No. Designer's Name,Address d Te.No. �6hrl Attnttk-. . 551 v�lr-� Pe ve n r 5 HA Z& es -X269 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 ff`10 gallons per day. Calculated daily flow 'Y�� gallons. Plan Date ! 245 Number of sheets Revision Date Title on Size of Septic Tank I Type of S.A.S. G J Description of Soil t -• r Nature of Re airs.or Alterations(Answer when applicable) l 5. t. iLz0 J1 — + aTVIE Date last inspected: To Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio s of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d y this Board of Signed &qAb Date (/44Z U3 Application Approved by4ZkAH1CC115- Date ( C� Application Disapproved r the following reasons Permit No. 3 Date Issued 03 No. !- Fee C, THE COMMONWEALTH OF MASSACHUSETTS Entered in compute ( Yes / PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS _application for Miopaal *p.5tem Congtruction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System WIndividual Components Location Address or Lot No.6p j I I`1 t'Lj}old e.Yl utc_. Owner's Name,Address and Tel.No. Assessor's MapTarcel i o ', O U+olpo2— NM �;ho oUnj r; „ Installer' Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � �5 ��U�77�8-(8y a John NY.�►,fi.�r �Eta- 4-0,2par, .44 L137-1-269 Type of Building: Dwelling No.of Bedrooms P n Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 5 1 4"„ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow (L/U gallons per day. Calculated'daily flow. gallons. Plan Date r N6-Vtrnber4l,U Number of sheets t Revision Date 1 Title r Size of Septic Tank . VIK 1 r fiVV Itw Type of S.A.S. ,rl 4-Y,0Cr,( . P Z . if r7 Description of Soil -b4-L r2 )'\_ P Nature of Repairs or Alterations(Answer when applicable) � Lh2--��1 s 1'i 1L� /0 �i�LL� —]-�.,v x nS I.a,U. ° (U W. 0- R bv- Q n(I b 001 G1 rv-,, --i H ,C . J'n V, '1 �-raro r`S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is tdbyth/ips Board ofHy"alth Signed . { Date � ) / � 7zL43 r Application Approved by . - �� , -r. , -- ; Date . 11./`? J Application Disapproved fdrthe following reasons Permit No. Lot) Date Issued I G3 I f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Compliance THIS IS TO CENT!IFY,Ithat the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by 1,L_ , at 6 1) \A � i 1 �6 /r V1 , t , M 6Lr�1 Oy l S 'M I I I S has been constructe o in raccordance with the prof,isions`of Title 5,and C.�N' a for Disposal System Construction Permit No. 3 s dated /1 �'� Installer _ �t�� .r!Ill_'�5 Designer _ r The issuance of this permit shall not be construed as a guarantee that the system wfll�unction as dresigned. •-4 Date 1I 1 g 103 Inspector -----------------------—_--------------- No. Z f� '-5 3� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpoml 6potem Construction Permit Permission is hereby granted IContstruct( ( )Rep ( X Upgrade(� )1 Abandoln�( ) r System located at �4.� VV 1 1 1 IIGt�L l /`P Y1(,l ►`'tr i 4 S rInA Hills 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:Construlctio must be completed within three years of the date of this pe Date: l o 3 Approved by TOWN OF BARNSTABLE o ' LOCATION to v �v� �� SEWAGE VII.LAGE ASSESSOR'S MAP & LOT 3" INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: .(type)• is�Q'Z_Iy (size) NO. OF BEDROOMS BUILDER OR 0 R PERMITDATE: . 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwate Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist j 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 i I I I �/ Q`�fjl o Zc . I 1 i j=: November 14,2003 John P.Hunter,P.E. 7 Weeks Pond Drive • Forestdale,MA 02644 (508)477-8268 Barnstable Health Dept. 200 Main Street Hyannis,Ma 02601 Re: 63 Willington,Ave Septic System Inspection To Whom it May Concern: Please be aware that I inspected the newly installed septic system for the subject property and the system was installed in compliance with the approved plan. 9ory truly yours, P enter, E. `CATI'ON SEWAGE PERMIT NO. VILLAGE IN.STA LLE`R'S NAME & ADDRESS B U I L D E R OR A =GY. D T E PERMIT ISSUED DATE , COMPLIANCE ISSUED �� .� �� f �� , �-__ i�� ,� � � �.., No............ ✓ ., .. Frss... ............ 'THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HE LTH ' 7. .......OF......... A............................ App irFa#ion for DispatiFal Works Tomitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst at• ��`` / '/ at dyes or Lot No. .... -� oc � ......... ------------------------------------- ------------------------------------------------_... O er Address -ion Installer Address QType of Building Size Lot.................... .....Sq. feet ^I U U Dwelling—No. of Bedrooms..........;?..........................Expansion Attic (4 Garbage Grinder ( ) p., Other—Type of Building ........... No. of persons------ ............... Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ ------------- -------------------------------- -------------------------------------•------------ W Design Flow.......�_.� -------------------gallons per person per day. Total daily flow--__.`. _0.._:....................gallons. WSeptic Tank—Liquid capacity/ji. ...gallons Length___-0........ Width.-.,,4.-..`.... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Piameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Z111yDosin t Percolation Test Results Performed by._> t-j C_.._ .!tie fz �.!Z_ ....... Date..__..�� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Djpth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O \Descripti n of Soil-•••••--•--••--• ----•- .•••-- � v �6r �' ----•----------�•-----•1�......................... .....--- �.-ed..---- .. :(----------------------------- W ••----•--•-------------------------••-•---•-•--•---------•-•--•••---•---•----•----•---• ........................................................•-•----•--•----------------- txj Nature of Repairs or Alterations— er when applicable----------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITLE 5 of the State Sanitary Cod The ersW to place the system in operation until a Certificate of Compliance has been 'ssu b e b rsig _.. ... . at Application Approved By...... .-• ----- •••••. �.r-------------------- ..... �• Date Application Disapproved for the following reasons_................._...............---------•----••-•------------........................--• ---------..... •-•-----------------•---•---........--------•--...----------•------------•------.._.•..----•-......-•-•--••-----••-•--••--------•--------------•-------•--•--•----•=----------------••-•••-••--•-------- Date Permit No.......................................................... Issued....P:�?- -7 _-- ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ........... .....OF....... . . ....a'74. .N............................................. �rdifiraft of TompliFanrr THHg IS TO C TIF , That iival `a isposal System constructed ( 4-10or- tRepairedby �! �.T ------- --------------. Inst ler at-------------Ufa...... �l/�!� '�------ ��1 ��-k-------------------------------- has been installed in accordance with the provisions of T •r�f The State Sanitary Code as describ in the application for Disposal Works Construction Permit No. _._. _.._�L.- --•--- da.ted._�.`._�_�-_2_..___'......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1-2 L DATE..... r� P.......................•-------•-.......... Inspector--• . . . ..... - ieN .......................J ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH ................... ... --------------- OF.......... ................................................................. Aurfiration for Uhipmal Works Towitrurtion Vvirmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System atr ................7 Li�I .. ........ e. . ....t .. ... ....... .6oca ion-.0 or Lot No. .. .. . .. ........................................ ............................................... Ow-e �r—r ess . . ........ ......................... ..........V .............................................................................................. Installer Address Type of Building Size Lot............................Sq. feet U -,Dwelling—No. of Bedrooms___-. 0.11" ......................Expansion Attic (4o< Garbage Grinder ( ) P4 Other—Type of Building .............. No. of persons___..________________--_----------- Showers Cafeteria ( ) Other, fixtures .4............................ ............*-----------------------------------------------*,-***------------"--------------------------------- .............. per person perday. Total daily flow.... .....in ..........................gallons. Design Flow._........... ........ gallons 9 Septic Tank—Liquid capaci vatt.O.gallons Length......4........ Width--->1ZO... Diameter................ Depth_._____.______.. t) Disposal Trench—No 7-------------- Width___ ............. Total Length...________.________ Total leaching area....................sq. ft. Seepage Pit No_____________________ iameter..................... Depth below inlet____.__________.____ Total,leaching area..................sq. ft. Z; Other Distribution box Dosing t Percolaktion Test Results Performed by . ...... Date '-.:_.. V,41 Test Pit No. I................minutes per inch Depth of Test Pit____-_-_..___..____..DI _ th to ground water____________________._ . (� Test Pit No. 2...............minutes per inch Depth of Test Pit__.....__._________. Depth to ground water-.______._..___.______.. e--------- ........................... ...... /--------110------------------------------------------- .................... -------------- /.. I 0 Description of SOP........ I/ ...............Y'...71.6?......................... ---------------- ............/ �4 -S .41, lot ............Mk.-e.d...... ...............AA.,Kk.,..............................................t............................................................ _-:t.. ............................................................................................ ........................... ........................................ U Nature of Repairs or Alterations—A-rrs��e-r A�wenapplicable---------------------------------------------------...............-------------------------- .....................................................................a......................................................................................................................... Agreement: The un4rsigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T T_Z' 5 of the State Sanitary Code_ The,pdersigned fur ree t to place the system in Abeenssue�b eb rdof operation until a Certificate of Compliance has f a S g ed.,,O,�. .......... --- ------ ... ................... ...e R n Dq� ApplicationApproved-Byz ... ....... .................. ......................................... Date Application Disapproved forRJhe following reasons:.............................................................................................................. .............................................. ................................................................................................................................:................ Date Permit 14o..............................t ............................ Issued_....................................................... Date THE COMMONWEALTH-OF MASSACHUSETTS "V, BOARD OF HEALTH ............ 0 ........... ... .4.......................................... THIS IS TO C TIF , That t iv d I z osal System constructed orRepaired by.....j"413;�n....I-, ................ .. ..................................................................: ...............................................AV- Inst at If_k-------------------------------- ..............Ze Ile: A)M.... ................1 xz_ has been instilled in accordaRce with the provisions of TI T of The State Sanitary Code as descr!i'bed.in the application for Disposal Works Construction Permit No.____..... ..... 3..... dated------ Y............. THE ISSUANCE OF THIS 'CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1 ,11. NCTION SATISFACTORY. 7 DATE.... ......... ....... . .............. Inspqcton...... .............. .... ... ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............7 .......OF.................... ................................ . ......... .... .. No.--_. ..... .....FS FEE........................ Moo anal v h.5 Tnngriull "r . ....... . 019 . _0...W..............................y granted_Permission is r . .......... . . . ........ to Construct etetpair PT5 ,//an Individual Sewage Dispo Sv'st J ..............................................................at No.---...C��7A_416 fie "fir' Street as shown on the application for Disposal Works Construction Permit No..., ........... tted-------0/..... Zr..... . ............................ ............. .........................................- 7 ♦ Board of RT"Mh " 4 DATE-- •- --------------------------------------------------.......... FORM 1255 HOBBS &,WARREN, INC., PUBLISHERS