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Home My WebLink About0044 LOCUST AVENUE - Health W Locust Avenue W. Barnsfable P A = 197 031 Page: 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory RFC�II,o Report Dated: 9/27/2005 Report Prepared For: Order No.: q53 216 2 9 ?Op5 Van Northeross N OF BArR, , P.O. Box 865 HEgCTN pENr,." W. Barnstable, MA 02668 . Laboratory ID#: 0533216-01 Description: Water-Drinldng Water Sample#: 33216 Sampling Location: 44 Locust St.W.Barnstable,MA Collected: 9/26/2005 Collected by: V.Northcross Received: 9/26/2005 Routine UEM RESULT UNITS RL MCL Method; Tested LAB: Inorganics Nitrate as Nitrogen BRL mg/L 0.10 10 EPA 300.0 9/26/2005 LAB: Metals Copper 0.63 mg/L 0.10 1.3 SM3111B 9/26/2005 Iron 2.9 mg/L 0.10 0.3 SM311113 9/26/2005 Sodium . 9.6 mg/L 1.0 20 SM3111B 9/27/2005 LAB: Microbiology Total Coliform Absent P/A 0 0 309 9/26/2005 LAB: Physical Chemistry Conductance 100 umohs/cm 1.0 EPA 120.1 9/26/2005 pH 6.3 pH-units 0 EPA 150.1 9/26/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: (L Director) 9 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 S-z zc). COMMONWEALTH OF MASSACHUSETTS UVEXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTALER PROCTI•QN E�liE� 1 ? 2005 sT B UNSTABLE TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 44 Locust Avenue West Barnstable, MA 02668 Owner's Name: Tom Johnson 3,3 Owner's Address: � Date of Inspection: April 11, 2005 / Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Inspector's Signature: Date: April 2095 -< C; The system inspector shall sub 't copy of this inspection report to the Approving Authority(Bb d of Heahh or DEP)within 30 days of completing this inspection. If the system is a shared system or has a des" flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regio I office3Pthe �c DES. The original should be sent to the system owner and copies sent to the buyer,if applicable, d the a�pprovit authority. '• 3¢ ►V — VD Notes and Comments r77 ****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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 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: 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 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 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.] 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 System: 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 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 44 Locust Avenue West Barnstable, MA Owner: Torn Johnson Date of Inspection: April 11, 2005 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44 Locust Avenue TVest Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a. [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,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 Source of information: Unavailable 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 ✓ 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: Date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Locust Avenue rest Barnstable. MA Owner: Tom Johnson Date of Inspection: Al2rd.11, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _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: ✓ (locate on site plan) Depth below grade: 2" Material of construction: ✓ 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: 1000.zal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 0" 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: 10" How were dimensions determined: Measurine 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.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage GREASE TRAP: None (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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 2005 TIGHT or HOLDING TANK: None (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: v' (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 ag L) 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.): The pit was dry. The scum line was 6"up from the bottom There did not appear to be any signs offailure The bottom to grade was 7'. The cover was 5"below grade. CESSPOOLS: None (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: None (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.): 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: 44 Locust Avenue PVest Barnstable, MA Owner: Tom Johnson Date of Inspection: April 11, 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. ao a 3 a.8 ay 3 y 10 J Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 44 Locust Avenue West Barnstable, MA Owner: Tan Johnson Date of Inspection: April 11, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: topographic and water contours naps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing_yMroximately 30'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system,the inspection and/or this report. 11 TOWN OF BARNSTABLE LbCATION 7AUC10(-US� SEWAGE # VILLAGE �• �3A/ns�.a6�. ASSESSOR'S MAP & LOT /9-7- D3/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ' LEACHING FACILITY: (type) ��T (size) ENO. OF BEDROOMS aZ •BUMDER OR OWNER PERMITDATE: COMPLIANCE DATE: 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 leas }ng facility) Feet Furnished by cc.�%u� ��/J ao 3 y 031 No...l. a,_ &J Fa$... .Q....``..'....... THE COMMONWEALTH OF MASSACHUSETTS APPROVED af ®arnstable C� vnt�tiwt DmeniBOAR® OF HEALTH WN OF BARNSTABLE ApphratioRaTur Ali;ipatial Wark,i Tnntrnrtiun 1krutit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System/fat: .........rl ... = ---- -------- ---- -- ------------•----------- . Loc on- 1,41 s or Lot No. .....tfBuilding • - - -- -•------•--------- -- ...._.O�. � ------, - AddresInstal r Address Ty Size Lot............................Sq. feet aDwelling— No. of Bedrooms.__-�---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons-----------................. Showers ( ) — Cafeteria ( ) dOther fixtures --------------•---------•-•----•-•-•---------- --------------------------------------------•--•--••-•---------•--_--•---••--•-•-•---..........----.. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter__.-_-_.______ Depth................ Disposal Trench--No. .................... Width.................... .Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._______...-.______ Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) " Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•-•---------------------------------•----------...-----•-•---------••-------------.........--------.......-----------.....-•----•................. ••--•-- 0 Description of Soil................................................................................................................................................ ............ x U --•...---••-••••-•••---•----...•-••-......-••-•-•---•-•---•-•••-•--•-•••..............•••---•••...........---._...... ••-•--•----•---•---••-•-••_•••••-••••---•••-•--••--_-----...-----•-_-........---- UW ............. ---------•-----•--•----------•..............•---•--------•--••-----------•-•-•---._- - - ------- -•-•-•---------•-•----•-•----- Nature of Repairs or Alterations—Answer when applicable. __. _____ _____________/®�Ql�_.__ .G ...... . ................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has ben issued y the board of health. Signed ....... . ..................................... ��® . Date Application Approved BY ................. ........_.. - -------------------------------------------- .................Date.... .............. Application Disapproved for the following reasons: .. ............. ................................._---.---. ................................................... .-- ........................ ......................... .....--......................................... . . ............................................ ......... .......................... Date PermitNo. ----- --------------------------- Issued ......................... Date .y,•-v.r-•.r1..r-r..-+'L*v-cr--..-.�F�YN_,BYO...�..,.,-v,,.iv—�...'�..I'_. r,.. L .i.-�.-1;t/�:, .:--;.+..�.._-a•y .. � 6 - 6 I C7 THE COMMONWEALTH OF MASSACHUSETTS V/ BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial Our1w C ontitrnrtiun �rmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loca ion- \d:Imss or Lot No. c ------------ •--------- .- ----------- ----•-------- O�cn J� Addres� (.4 7 J f= 1 -- Installer o Address VType of Building Size Lot............................Sq. feet .a Dwelling—No. of Bedrooms.__. '3.................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------._.....--------------------------- -----•---------•---•••••••••-•••--•-•---••......---.......... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter.-._.-_.--____-_ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.-__._____._._._.._. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box.(, ) , Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................tninutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit._.__-__.._-___----- Depth to ground water........................ 9 •-•-••-•-•-•----------------•-•-••.........-•-.........----••--•---...............---•-•-•--...........-----•........................................................................... 0 Description of Soil..................................................................................... --.---•--------•-•-----•••---•--•••-•----••-••-----------------................... x U .............................................. •------••-•-••••-•--•-•---•••--•---•--•••-•-----------------•••-------•-----------•----•.....-------•••••-••-•--•-•----------------•-•-••-----•-•--------. W �. , x .a.i..._a...�. U Nature of Repairs or Alterations—Answer when applicable.. _- - 1aZU_ � ....... ........... .� -------- •..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed - . .. . ..y...... -- ................................ A!�. /11T' G Application Approved By -- -------------------------------- ` r gte.................. V Dare Application-Disapproved for the following reasons: ...................... ....................................... .............................................................. . .............................................................................................................................................................................................................. ....................................... 61 Date PermitNo. ----1..?,.-----------------.1 - Issued ................................... .. ..................... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cler#ifirate of C ampliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (>° ) by -------------- ... - ................... ......-----------------_ 1� Insrillc•r ............. _.......... ,,J aC .......... ..a._.rYA_! .............-- pw<[ Q - .....- _............................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._.�.3.-.�}��..1......._.. dated _..._................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .......... I f-`--..�� .. ......... _- Inspector ..---,..... .:/...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No... -�- G I FEE........................nrla� �.un�trirrn �rrmit Permission is hereby granted...........)p Me:? ---------� . +r ..__. ._ to Construct ( ) or Repair (fie) an I'ridividual Sewage Disposal/System �•. . ........... ..................................... ........................................... Street �� as shown on the application for Disposal Works Construction Permit No�2_-._��t`__ Dated_.---_____/ ................—9 ............................... �....... -- ------------••••----•--•-••---------••- Board of Health DATE.............. - U - �/ ------------- `,. FORM 36508 HOBBS,E WARREN.INC.,PUBLISHERS LOCATION SEWAGE PERMIT 140• —qq Lcvc /y 77 d I L L A G E 66 9'7 1�3 3 J -qlr ,INST LLEa SS .NAME 6 ADDRESS a u B U I L 0 E R OR OWNER DATE PERMIT ISSUED 4"4` 2 DATE C0rAPL1ANCE ISSUED z �i 1� P_f+�� t. No.5 t.....d...-7 Fiz$../.....r............... THE COMMONWEALTH OF MASSACHUSETTS � BOAR® F` HEA�LT / LJ ..----..-. ._-ev -.. OF.....� /!/�✓...� ��---------------------- Applirution for DiipnuFal Works Tonstrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (4.)''an Individual Sewage Disposal System at: ......�r.� �.11 .. .. f1 .c:� ,,.... ---------------------------------------------------------- Lo� ddress or Lot No. (y ................................................. caner [ / Address ...............:... � _��.�.`.........._�.\!� ------------------------------•-•-------..._ Instal'er Address Pq d Type of Building Size Lot.....:......................Sq. feet U Dwelling o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa,, Other—Type of Building ---•-•---•-•____________... No. of persons............................ Showers ( )' — Cafeteria ( ) Q'' Other fixtures ........................................................... W Design Flow..............................:......•----__gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results 7Derformed by.......................................................................... Date....................................... aTest Pit No. 1................rr-inutes per inch Depth of Test Pit.................... Depth to ground water----------------------- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...-.................... x ---•---- - ------------------------------------------------------------------------------------------------------------------------------- ODescription of Soil ---- -- •-•..........................••--•.._..---------------------•----•----•--•----•-----••-----...-•---••-------•--•-•---......-•-•---- AC x -•-------------- ---------------------------------------------------------------------------------••--------- -•---- V Nature of Repairs or Alterations—Answer when applicable___. 1 ___________________________________� .... -.eo...... -•--------------------------•--------------•-----------•--•------•--------•---•---------------------------------------------...-----------------------•-----------------------........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by t f 1 lth.Signe :,Vbo5 ". ..... - < :. to Application Approved By-----•-•-•• -----• ------ :... .................................................... ------------- Ij(` ' /Date Application Disapproved for the following reasons:.......................................................... ................................................... ......---------•-------•-••---•---•------•---•-......--•---------------------•-•-••---....._...--•--•...._..........._...-•---------------••----•-•-----•--•-•--------•--. ----------------------------- Date Permit No......... ---.L d-M--------------- Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No.. `l" !t 7"1 Fim..� ._.... THE COMMONWEALTH OF MASSACHUSETTS BOARD ?F HEALTH Appliratilan for Dispaii al Works Tonotriyrtinn 1hrutit Application is hereby made for a Permit to Construct ( ) or Repair (,r...J' an Individual Sewage Disposal System at a ` Lo.,tion.;VAddress or Lot No. r Owner r Address W ..... ....... ........ � .. • Installer------------------- ..................� ------- .�... ------------ r. .------------------------------------- ------- � Adess.. d Type of Buildin'g�** Size Lot............................Sq. feet Dwelling•� . of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures -----'-"-'----•'-"---•--'-" W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter_______•____•__• Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.___.__-.___.___.___ Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) " Percolation Test Results Performed by........................................................................... Date........................................ ,aa Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------------------._. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ xr' � '"---••--•--------'----'----------------------------------------------------------•--•---------••-•-•-•-••-------------....---- ODescription of Soil------...-r�:a�![[-�_._�=s� -----'-----------------------••'.................................................................................................. W -� ------------------------------------------ r r U Nature of Repairs or Alterations—Answer when applicable._....Z:7:..f.__ --__-- .,.�--' ' -- r^" 1........ -----------------'-•-'•------"'----"---'--"-----•--••---•------•--•-•---•-•"-..........----'---'-----"-----•----'--"-'-'--'-'------'------•-••-----•-------'----'-----•-•---•-•-----------....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.fe 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by�he board of health r � r g .. . 1 fir ,•�/ f t Date Application Approved BY--'- 1 x'. -�F• .ty_!'` --------------------------•------- f _....----'-. Application Disapproved for the following reasons:..............................................................................` ..-•-----•--•-••---•------....-'--"---�-------"� -•----.....'------- -----------------.-•--------------------------------'-----................................... -----•.....-_. Date PermitNo.....---- ---. -v y----`-7................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,,f.. ..�-,:.. sr�,, .. ... O F... ............ Trrtifirtt#.r of Tnutpliatta lT-WS4IS1TQr CERTIPY,xThat the Individual Sewage Disposal System constructed ( ) or Repaired (X' " ,"✓ P° r° ........................ ................. ............................................................................................ I Installer .............. .........................._ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit dated......... ___________________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GU Al EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ �`� f........OF.....�� r ''. S' ✓ i� .................... 6" ! FEE............!.---••--• Bisvos,Fal Worko 011a1ttstr ion rr? it Permission is hereby granted.............. .�' - r to Construct )f —)or,Repair an Individual Sewage,Disposal System at No. 11/!!�IZ loel 0-/, f' -r -............................................... ...................-----'-•--------------•--'----'-----•----------------..........._. Street as shown on the application for Disposal Works Construction Permit NSFy-Le?..' 7- Dated._1.1/34/Q.................. Board of Health DATE......................................--........................................ FORM 1255 A. M. SULKIN, INC., BOSTON No. .........(.: Fps...:'..Q................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a -•----- � .........O F.............. .... . . ................................................ Applira#ion for Bwvvx al Works Tontrnrtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys ! .............................................. .................. .'-................ .. N -•----------.......................-•"-- rLocation- ddress ................................ ort q ......................... / Owner �. vAddress / a h ti f �i /r� .. 3r% r3/ti.r r. l ,�► y s b/e_. w _... . ... . --•--- -•---- ..-------- Installer Address a'"S d Type of Building Size Lot....... ..................Sq. feet Dwelling—No. of Bedrooms........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length------------_-- Width................ Diameter______--__.-_- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.•________ _________ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....................................................................----• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-_____--._._._______ Depth to ground water........................ (i Test Pit No. 2--___._•-•____-_minutes per inch Depth of Test Pit____________________ Depth to ground water........................ P4 ------••--••--- ---•-----•---•-•-•---•--'•-----•--•-------•---.....•-••---••--•------'---'------------•---•-'------------•--•---•......................................................... 0 Description of Soil....................... .--------------------------------•------------------•------------•-•-••--•---------------•----------------------•--------•---- U --....-----•-•••••----------•--------------•---••--------------••-- •-•-•--•---------••-----........•----------------.._..•-----•-•--------•-•••-••-••'•-••••-•-••-'------------•-•--••-----•'•--- W •--•-•-•-=-----------•---- -------------------------------------------------- o = U Repairs Alterations—Answer when,applicable._--__�'��lpr'��!"f_. !�!� !''�___JyJ7t?^ w` 4________________ Nature of Re airs or __ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been .ssued by�theeoard ofhealth. Signed.--•-•- •-----•----- .........................'------------•-----•--- ................................g"7� ,s14 Date ApplicationApproved By-•--•-•--••-•----•-•---•-----•---------•-----•---•---•'-•----------------••---••-•-•-----------. ----------•-------..----- Date Application Disapproved for the following reasons:--•---•----------•------•-•----••------------------------------•-•-•----------------•-•...._......---......•---- ---•-•--------•-•-•-•--------•-----••--------•-•------•-•---•-----•---••--------------•----•----------•. -----------------------------------------------------------------------•.--------•------------- Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ALTH ...........� ...OF................... ... .... .............................. (Irrtifiratr of Tomplianrle T S 1 TO CE Al2 he Individual Sewage Disposal System constructed ( ) or Repaired by - ......_... -----•.-- ------•........-' ---- ------------------•-----.------.--------------- Ins er at--f---. .. =....... `--------- G Z has been i stalled n accordance with the provisions of � j of The/.State Sanitary Code as descri ed in the application for Disposal Works Construction Permit No ______ ________y-. ........ dated---.--- . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... .l 07f No ........ ..... FEB .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....OF.............. {{r? �.. Appliration for Binponal Works Tonotraartion 1hrmit Application is hereby made for a Permit to Construct. ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_.........._...........,...... .._ _.••••-• -•-••--------•-•-•--........... ............--••-_....e.--•---......••------.....--•----------•--------.........................: !' �L�ocati�f ress ,d04't4 wR or T wNo r ......................_.•..1 ...............................................................�I�► ......................................................... a 'I.. ....---�-f W r eti"I�I '� �Saj".0/ gAd r R w...................... .....•-•-•• --••••-- -•-••---••--•----••. ......•. , �........�......---•-----•-••--- Installer Address Type of Building Size Lot____-.p---.............Sq. feet Dwelling—No. of Bedrooms.......'4...................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building --------:................... No. of persons............................ Showers a � ------------•---•-----•-•---------P ( ) — Cafeteria ( ) Otherfixtures .............. --•--....-•--••-•-------------------- -----------•-•-•--•-•--•----•-•-•---. W Design Flow........................................:...gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution'box ( ) Dosing tank ( ) '-, Percolation Test Results Performed by.................................................................... -•--- Date................................. Test Pit No. `I________________minutes per inch Depth of Test Pit.................... Depth to ground water__________--_--------__. �X4 Test Pit No. 2.................minutes per inch Depth of Test Pit................::.. Depth to ground water------------------------ ------------ ----- --_---------•--------------•------------•--.....---•------------•--•-•-•----•----------------•---••-•-•--- . ..._...... O Description of oil-------------------- ----------------------------- ---------------------------------- ------------------------------------ U Nature of Repairs or Alterations—Ans er en applicabl t dta► !0?o ... fir:+ Agreement: The undersigned agrees to'-install the aforedescribed 'Ind'ividual Sewage Disposal System in accordance with the provisions of'TT W : p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ss d by thehard eal Signed---- Date ApplicationApproved By............----------•---•----•-•------...--------------_--•------..................._-•-•-•-•-- Date Application Disapproved for the following reasons--------------•-------------••-•-•-------------•---------------••------------•---------------•-•-•--•--•--••---- -•--•.........................••-•--•••-•-•......--•-------•--•-•-•-----•-••------•--••----•-•----•-•-- ------=------------------------•----------------------------•------------------------------ w Date PermitNo................................................. -,. ., Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS N BOARD OF ALTH ........... ..V4�. . OF................... ::'aevI `i ........ .............. rrtifiratr of Tontpfianrr T S I TO CE Y' e Individual Sewage Disposal System constructed . _or Re aired by..- . ---- _..... .......... •.............. •--- --------- Jr�l! Inst er ,yam A has been in,tad lied n accordance with the provisions of T "" j of ee State Sanitary Code as esc }e in the application for Disposal Works Construction Permit No._ ; __.____ .._....... dated_. __-_ ""_ `_-!'..�_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT. BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUiICTION SATISFACTORY._ .._DATE DATE........,-:-----------------•---•-•--•---------------.----•--------------------. Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS %'1* BOARD HEALTH 7 r_ej ..OF. ..:... :. �....................... ••w" Nn FEE........ ............. Bio�ro' tt ko o cart panfit -- - ------. �----- -- -- � ....................................... Permission is hereb r nte. - " tc Constr ( * ) or Rep ( ) a ndivldu age Dis o S em a� No. jC r ' f� J/ Street as shown on the application for Disposal Works,"Construction Perm' ........(---•-._.. ........ ._ ,r Board-oft Hea DATE ... ..... ... .. ...................................•-• . .-- FORM 1255 HOBBS & WARREN, ING.: PUBLISHERS - p FIR p C t l f .� C ' AY 1 ;P "77w A O C u S i 5.4 i } A I � , t i