HomeMy WebLinkAbout0119 DEBBIES LANE - Health (2) 119 DEBBIES LANE, r
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' Department of Regulatory Services
M Public Health Division Date (l F
ibsy.. -�200'IViain Street,Hyannis MA 02601
Date scheduled Time Fee Pd.
y Soil Suitability Assessment for ale Disposal
Performed By. Witnessed By:
LOCATION &GENERAL.INFORMTION. Z
Location Address Na
- Owner's
tq �e55"yes jam,... 0 J-e_ ,
q r.5 ✓`l l^'I t(s Address )IT P4&6 l V, La'^
Ivl o�sl-�ns .as Mn 4 Z yg
Assessor's Map/Parcel: Z 7 —/ 36 r A 11 Engineer's Name
NEW CONSTRUCTION REPAIR:_ Telephone# _ Qr- 37- 10F
Land Use, 5�� Slopes Surface Stones
Distance9 from: Open Water Body S`� ft Possible Wet Area �ft Drinking Water Well � �ft
Drainage Way ft Property Line -� 2O ft .,Other ft
SKETCH:-(Street name,dimensions of lot,exact locations of test holes&Aerate ,locate wetlands?n proximity to holes)
ts" 2e `
LI7
s 3 CD
r'• -rO
Qq
E _
Parent material(geologic) Depth to Bedrock
Depth to+Groundwater. Standing Water in Hole: Weeping from Pit FAce
r.
Estimated°Seasonal High Groundwater
-DETERMINATION FOR.SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.halc: la, Depth to 5911:motti@3e 1t1
Depth to weeping from side of obs.hole: An, Groundwater AdJultmeflt ft. )
index.Well:# Reading Date: Index Well level Adj.&ctorf,,_ ,Aid{:"drnUfld:WaterLevel,,,,�
PERCOLATION TEST bate , Time
Observation
Hole# t' Time at 9"
Depdrofftrc. 4, Time at 6"
.Start Pre-soak Time® 2. l Time(9"-611) ,
End Pre-soak
Rate Min-
Site Suitability Assessment: Site Passed, Site Failed: Additional Testing Needed(YM)
original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 1009 of wetland,you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTlC\P8RCFORM.D0C
DEEP.OBSERVATION HOLE LOG Hole
Depth from Soil Horizon Sod Texture Soil:color Sod Other
.Surface(in:) (USDA) (Mansell). . Mottling .T (Structtire,'Stones Boulders:Witt
,
/ 5... li
Alp
1-7
r� - ..
DEEP OBSERVATLONHOLE T,OG Hole# 2—
Depth<from. Soil Horizon Soil Texture Soil Color Soil Other
li ..
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders:. .
DEEP OBSERVATION HOLE LOG Hole#
Depth:from Soil Horizon Soil Texture. Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders:
• 1
DEEP OBSERVATION HOLE LOG Hole#
Depth`from Soil Horizon Soil Texwre Soil.Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;8ouldtrs:
,
., F'lood�,nance�,Man
A weS00 earrfiood'boundary'.No Yes.
witm- 500 year boundary
No� Yes;r.
`• t
within 100 year flood boundary No_..� Yes
<.De th,of Natura.4':Occurrent=_Pervious Material
p 1 m is.observed'throw pout the;..
Does at leastfour feet:of naturally occurring pervious material exist in am 8....
area.proposed for the soil absorption s)stem? �'�
7i o-uss-m-a-t-e-r-ial?`
If not,:whatas'the depth"of naturally occurring p�ry
Certiiicatton
I certify that'on .(date)I have passed th e soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required:train ;expertise anglexperiena d4scHbed in 10°CNTR 15.0'1'1:
Signature .. a D tb
Q:10EpnOPBRCFORM.DOC
TOWN OF BARNSTABLE
L OCATION �'F�� oi�S�-� SEWAGE#A Ola I w75
VZ,LAGE M�,rs�(K,+«S ASSESSOR'S MAP&PARCEL7
INSTALLER'S NAME&PHONE NO. aJ• ,e -.
QkMr-
SEPTIC TANK CAPACITY 10'00
LEACHING FACILITY:(type) (size)fj ��eM)Sot
NO.OF BEDROOMS -3 ABC ¢ — v_An&n, 10, ;;�6
OWNER-6--LICk cs++d�a.,.��1 1�oSQ•�
PERMIT DATE: '" e c3 O t( COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility $, p` Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) wA , Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) /V liq Feet
FURNISHED BY �� c
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GHQ 9G /
t 14
Or. G
Po7 3 NLI
G
H as ya.
112,
TROY WILLIAMS rJUN
SEPTIC INSPECTIONS 9
.9 , AO
96
Certified by MA Department of Environmental Protection `'► (508)'760-1819
40 Old Bass River Road CP
„f
South Dennis,MA 02660 VIF
� p�
Commonwealth of Massachusetts O
Executive Office of Environmental Affairs
Department of
Environmental Protection
WQNam F.Weld Trudy Cox*
Govemor .seffat„y
Arpw Paul Celluccl David&Struhs
u Gmmnor Corrvriwbrrr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: I N D<-46;e-5 Li, 5 Address of Owner. l��rs 4 F2dc.ro � Ste.✓;1�S a K.:�
Date of Inspection: G 1'7 19 6 (If different)
Name of Inspector:��rby r 2 I'L.-r.s
Company Name,Address and Telephone Number. /G Lovr
025 g�F
:5�C- cy.l ,« R tV Y /Y6 dy
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
asses
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature /J ��WeY✓L Data
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or bas 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 Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination is all instances. If"not determined",explain why not)
The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is
imm rent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address; A b� , .,-
Owner. FF S+L.
Date of Inspection:
Bl SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four 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
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /V,/,
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution iirom that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) OTHER
(revised 11/03/95) 2
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner. �� S
Date of Inspection: / g b
D] SYSTEM FAILS: /1114
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
— Backup of sewage into facility or system component due to an 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 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation.
— Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
ooliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. --
EI LARGE SYSTEM FAILS: IV119
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
— the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public
water supply well)
The owner or operator of an such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CUR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/915) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: i ►y ,d�6 ; e-
5
Owner. F F S t L
Date of Inspection:
Check if the following have been done: `
✓Pumping information was requested of the owner,occupant,and Board of Health.
"/ O N'l6aw 7 ti S
None of the system components have been pumped for at least two weeks and the system has been
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
ZAs built plans have been obtained and examined. Note if they are not available with N/A
ZThe facility or dwelling was inspected for signs of sewage back-up.
•JLThe system does not receive non-sanitary or industrial waste flow
tZThe site was inspected for signs of breakout.
Je_lAll system components,excluding the Soil Absorption System, have been located on the site.
✓The septic tank manholes were uncovered., opened, and the interior of the septic tank was inspected for condition of baffies or
tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
ZThe facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System. -
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: oe
Owner. �= F S (—
Date of Inspection;
G /7 /�6
RESIDENTIAL: FLOW CONDITIONS
Design flow U a�l.1/ons
Number of bedrooms:�L
Number of current residents: U
Garbage grinder(yes or no):_ %f6
Laundry connected to system(yes or no):—Zr S
Seasonal use(yes or no): ^0
Water meter readings, if available: (it1 j ) y 4- ty
Last date of occupancy: v , �'L.o h 4,4 S
COMMERCIAL/INDUSTRIAL. At
Type of establishment:
Design flow:____gallons/day
Grease trap present: (yes or no)
Lndustrial Waste Folding 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:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Na �"w+ i ✓�4 c c d v-j:A S T y� --
System Pumped ali part of inspection: (yes or no)NU
If yes,volume pumped: ml ors
Reason for pumping:
TYPE OF SYSTEM
Septic tarWdistn'bution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yea, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installeflif known) and source of information:
�
Sewage odors detected when arriving at the site: (yes or no) Aid
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
c, SYSTEM INFORMATION(continued)
Property Address: I Ac b 6- c.S
Owner. �—F S f L
Date of Inspection:( / C(d
SEPTIC TANK:
(locate on site plan)
Depth below grade:�
Material of construction: concrete_metal_FRP—other(explain)
Dimensions:_
Sludge depth � ��
Distance from top of sludge to bottom of outlet tee or baffle: G? /
Scum thickness: �•
Distance from top of scum to top of outlet tee or baffle: G ��
Distance from bottom of scum to bottom of outlet tee or baffle:
Comments:
(recommendation for pumper.condition of inlet and cut t tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.7 5 6.)e✓- -1 yt ' H k
rC
GREASE TRAP v a s �.
(locate on site plea) Jv14 L' 5 i � ✓ (J L.,/�'h ,rc ro a
Depth below grade:
Material of construction:_concrete_metal_FRP_other(ezplain)
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:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or banes,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: `� ��/�., c S
Owner.
Date of In
spection:
TIGHT OR HOLDING TANK: IVlft
(locate on site plan) _
Depth below grade:
Material of construction:_concrete_metal_FRP_other(explain)
Dimensions:
CaPacit.r. ¢allons
Design flow: pUo*day
Alarm level:
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: IGv s�
Comments:
(not,P if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.)
✓rn � .t�tJ c.� h i ti o r � i_ o� .t t-v p Ga.. c e. �a �o u 'o
t
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances,etc.)
(revised 11/03195)
1
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: / / �G ; c s
Owner. `- F J-
Date of Inspect(on. 6 1.2
SOIL ABSORPTION SYSTEM(SAS):
(locate an site plan, if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type:
leading Pits, number:6ht /r'c-c, c. cd
leaching chambers,number._
leaching galleries,number.
leaching trenches, number,length:
leaching fields, number,dimensions:
overflow cesspool, number:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) a
aC J G c✓� t J c.��. i S
1_ e t ✓ e a
C POOLS: ALA 1 7
7 c a e 13"O0-e
(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(cesspool must be Pumped as Put of inspection)
Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
PRIVY: /1//A
(locate on site plan)
Materials of construction:
Depth of solids: _- Dimensions:
Comments: (note oondition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 11/03/95) 8
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: l l I a.J. ',-.3 L"
Owner. FT L
Date of Inspection;
SKETCH OF SEWAGE DISPOSAL SYSTEM;
indude Ges to at least two permanent references landmarks or benchmarks
locate all wells within 100'
5
3 �
60 � fro •. =
sa 3k �b �q
�{a 36
`��" 5 pat✓
,Q0
DEPTH TO GROUNDWATER --
t
Depth to.groundwater: feet adjusted high groundwater level:
cJ �
method of determination or approximation: S' �i ,f� �aAll s
LCA.c
9
9 .
TOWN.OF BARNSTABLE
Lam'° .'mON L f 9 Oe L I gL�n .b SEWAGE# —57J
VII,L :�iE_T, % 1Cl �'• ASSESSOR'S MAP & LOT a7- � d
INSTALLER'S NAME&PHONE NO. �� ✓
0
SEPTIC TANK CAPACITY
LEACHING FACILrrY: (type)_�_ (size) /rG / " f� �
NO.OF BEDROOMS 3
BUILDER OR OWNER GLz-
PERMITDATE: AL 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 I achip$facility) Feet
Furnished by
u
f
". :l 1 TOWN OF B.ARNSTABLE
6
LOCATION Z�6e 10�1J�s `Z_4 SEWAGE
VILLAGE,C�,CG2�4J Ai ASSESSOR'S MAP & LOTX?
a
INSTALLER'S NAME dz PHONE Nd.�.
SEPTIC TANK CAPACITY pia'I
LEACHING.FACILITY:(type) /� (size) G w Z
NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNERi+��'e
DATE PERMIT ISSUED: T-3)- A 7
DATE .COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No /
• ' l
J
�a
No.....�.7 nS.25- , f Fmc
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD .,QF HE_AOL/�TH
( 11. ..................OF............ a( d.1/1e&c...........
Appliratiun for Uhipouttl Work.5 Tunutrnr#iun ramit
Application is hereby made for a ermit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System t: / Z19..... '% . ..G. .... .... c..----... .v,- 1�....1,r.�..... .
Location-Address or Lot No.
_/ �.......---•.................. •----.................------•--••--•------ ----.....------................................
Owner Address
w -=. < ......................................... ..............--•--............--•-•-•----...........-----•-•--••---•----•---•-•...---•----...--•-
Installer Address
d Type of Building Size Lot............................Sq. feet
v Dwelling—No. of Bedrooms......�.................... .Expansion Attic (�/ s Garbage Grinder
Other—Type T e of Building No. of ersons............•............... Showers
a YP g -------------•-•------------ P ( ) — Cafeteria ( )
Q, Other fixtures ------•----•.............•--••-•
w Design Flow.............-..` ...................gallons per person per day. Total daily flow..........2.-�'D....................�lons.
WSeptic Tank—Liquid capacity..A� hi.O.4.tallons Length.(.t..�._._ -:.•.---..Width. ..':-..... Diameter................ Depth-.._._.__.......
x Disposal Trench—No... Width.................... Total Length. ......... Total leaching area............._.....sq. ft.
Seepage Pit No..................... Diameter.................... Dep low inlet.................... Total leaching area._ ... ft.
Z Other Distribution box ( ) Dosi to
aPercolation Test Results Performed by...... e2........ ... . l........................ Date.....�z�.' ..
Test Pit No. 1................minutes per inch epth of test Pit.................... Depth to ground water........................
(4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------- .........----
P4 ...........••-•--•-•-•-•----••-••-•••--•-...•••••...........-•.........................•--------•------•----•-•••--•-•------...............------....--.•••--
0 Description of Soil........................................................................................................................................................................
w
UNature of Repairs or Alterations—Answer when applicable...........................................................:....................................
----------------------------------------------------------------------------•---•••-.....------••...•••..-•-•-•••••••--••••••---•----•--•-•••-•....--•-•-••••..................................•--:.....
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5,of the State S Code—The undersigned further agrees not to place the system in
operation until a CerAjfAtepj Complianc has ed by the boar of health.
Signe O
Application Approved By................... - ----- .. ...... .... . ........3_f_^ft-g
Date
Application Disapproved for the following reasons:-----•....................................••----------..:.....---------------------------=-•••-•-•-•-•--••--...
...............•-••--•-----••••........•••••-••••--••••.......---•-•••----...-•-••-....---,.....................•-•-----••-•--•--•-•••••....-•--•••••-•••---•••......•••--••-•----•-----••••----......---
Date
Permit No..........32--:5..151---....-.._ Issued_.......................................................
` Date
l_
THE COMMONWEALTH OF MASSACHUSETTS'
BOARD OF HEALTH
...........................O F.............................................
Appliratinit for Biipn,ial Workii Tnnitrnr#inn Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: � �
....-------1 ' ..---.......! �.i°C� . 1 --...-•-----••---..2,0........1--a--.....---- -
Location.Address or Lot No.
C...... ....... fl'dl?1 ............................. .............................................^---..............--•---............................
Owner Address
a ...........................
.:..... ...........................------........ ..---------------------.... ...........................................
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.........?................................Expansion Attic (W _ 5 Garbage Grinder
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ................................. .
W Design Flow............ ...` ...................gallons per person per day. Total daily flow...........2..3_0....................gallons.
WSeptic Tank—Liquid capacity., ItCr allons Length. ....�y.... Width- ..... Diameter................ Depth.... ........
x Disposal Trench—No. ...Dt✓%..... Width.................... Total Length..?-.a.�............ Total leaching area....................sq. ft.
Seepage Pit No-----------_-------- Diameter.................... Dep elow inlet................... Total leaching area...:?.;'�?.....sq. ft.
Z Other Distribution box ( ) Dosirq,,tan /�
~' Percolation Test Results Performed by....... .EyiA�7........ ..%3�Q=G..i........................ Date......4......2 �C..
Test Pit No. I................minutes per inch Depth of est Pit.................... Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------- ...............
---•-------------------------•-•---•----•-------.....----------••---.............-•----------------..........................................................
ODescription of Soil........................................................................................................................................................................
x
w
-------------- ------------------------------•-------------------------•---------------------------------------------------------------------------------------------------.....-••---•----------------
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--•-•---•--•-------•----•--•-•••..............•--...---•.....-----------•--..............................----...--•---•---•-•••-•••-------•---------•----•-•------••--•----•-----------...------.......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State S Code— The undersigned further agrees not to place the system in
operation until �a Cer ' to Compli., has by the boar f health.
Signe . .,.......n 4",. ...Cl ---•- -------•----------•-----. y...
ate -
Application Approved By................... .. --•-.1 .--.�----�- �--�- . 3 -' 917--
Date
Application Disapproved for the following reasons-------------------•------------•----------------•-----------.....---•-------•---•------- •...............
----------•----------•---------------•---••--•----•---------......--••----...---------•--.....................................-------------------------------•--•-....-•--------------•--•-•.........----
Date
Permit No..........E-7---5--757-------•-------- Issued........................................................
...-----•--------••----••-------•..... ..........:
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTHC_�
14.A_Z1Q...........OF.... �• .1,7• �:.................................
CIrrtifiratle of Tnntpliatta
THI I TO CERT4FY, hat the Ifidual ewa Di sal System constructed ( ) or Repaired ( )
by ... ..�� . �/1 1 ... ....l .rs ... �.lr,,................ .
/ .
Installer
at ......... O.-l1•.--.... ........ i ./t/!_.
has been installed in accordance with the provisions of TIT t7n,_55 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No..----_ ..7..!�"._. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................... `:. ..._ .o.. _ ............................ Inspector............... . ..................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD ;OF HEALTH
..................
OF.....�...�:� �? z� 7
_.,7....:..1. FEE........................
�i��n��l�rk��#rnr#inn anti#
Permissionis hereby granted..............................................................................................................................................
to Construct ( ) or Rep 'r ( ) an ividgal�S gage Disposal System
at No. -�Cr`l c ��i� -! /�y'1I `. ----•---•..............•------------•--•--------.......
--.... .. ... .J
Street
as shown on the application for Disposal Works Construction Permit No...................... Dated..........................................
----•-•-----....-•------•-----•-•-•-••.....................•------------•-••---------------......_.......
Board of Health
DATE.....................................................•-•----•••----•----•-•-----
FORAM 1255 A. M. SULKIN, INC., BOSTON
f,
ENVIROTECH LABORATORIES
449me13- Sandwich, ma053. (61\ 8 8-646
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EDcey Homes LOCATION: 104 bbies .CLI ENT k ADDRESS- 10 W. Main St. M rston's Mills
/ §y nnis,M 02601 _
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� COLLECTED BY: Meehan SAMPLE DATE: 8/24/87 TIME: 2:20 PM �
R .
DATE RECEIVED: 2/55/BB SAMPLEID: R 588 ]
` New Well 3 £t.
JOB t WELL DEPTH:
k . a
/ RESULTS OF ANALYSIS \
� Parameter Units Recommended limit Result
�
� _
k Co f m b c r/10 m| (mF Method) O 0
R —
1E.: pH pH units 6.Oa3 k
5.59 %
L Conductance umh scm 500
. 106 ~
E
Sodium mg/L 20.0
9.5 2
E NU+e N mg L 10.O 1,03 g
Iron mg L 0.3
<.0
F _
— Manganese mg/L 0.0 m
E §
/ Hardness mg L as CaCOa 5O
.
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F. Sulfate ' mg/E 250
7
¢ Potassium mg/L 2§\
� . _
k Alkalinity mg/L 200
F _
Chloride mg/L . 25
EE
L 2
% d
2
tm .
/ T COMMEN q
E
E �
YES N 2
XXI Q WATER IS SUITABLE FOR DRINKING PURPOSE FOR PARAMETERS E TED 7
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DATE 2
m�l� �1!! �u m&� .
LEVY & ELDREDGE ASSOCIATES, INC., ������ 0� �QQ���D��Q�
Engineers - Landscape Architects - Planners
Land Surveyors
712 Main Street
HYANNIS, MASSACHUSETTS 02663 DATE , JOB NO.
/� - I'Zg7
(617) 775-2244 ATTENTION
RE:
TO
lJ vv� Z-0
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
COPIES DATE NO. DESCRIPTION
. 7 f c Dons
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit copies for approval
For your use ❑ Approved as noted ❑ Submit copies for distribution
As requested ❑ Returned for corrections ❑ Return corrected prints
❑ For review and comment ❑
❑ FOR BIDS DUE 19 ❑ PRINTS RETURNED AFTER .LOANN TO US
REMARKS nn Ai E"i7 9/j Sys V/CS/Z�
L% �lcl7t�Tln�4� aLy l/
Ld Z>,e c &e '6wa lye"
r �v Lei i 14-2 /-ZeV`a
COPY TO
SIGNED:/"-;Z
PRODUCT 243 Ees Inc,Ikohn,aria 01471. It enclosures are not as noted, kindly noti us at once.
TOWN.OF BARNSTABLE
I LOCATION 6. SEWAGE #
VII,LAGE +� % �'• ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO..
.. - SEPTIC TANK CAPACITY / U
U
LEACHING FACILITY: (type)P_� (size)
NO.OF BEDROOMS
BUILDER OR OWNERt �..
PERMUDATE: ?COMPLIANCE DATE: j, /I X
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 offIhin$facility) / Feet
Furnished by 7 % l ( ' k.
� s r s 4-s.�VI �s
� ) s
I
MAY,
Neighbor
NEW Existing
11,Ut
Lead T s 3/8�, tank
DBox 6,0., \5,4',)
l �
I
Road
o�THE,j Town of Barnstable
, ' Q+
Department of Health,Safety, and Environmental Services
BARNSfABLE,
MASS
s679. Public Health Division
♦0
alEoA P.O.Box 534,Hyannis MA 02601
Office: 508-8624644 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
June 1, 1998
Al Wohlwend
P.O. Box 76
Cotuit, MA
RE: Septic System Inspection Requirement/Cotuit Inn
923-925 Main Street, Cotuit
Dear Mr. Wohlwend:
i
'The Town of Barnstable Public Health Division has no records of any septic system
inspections conducted within the past three years at the above referenced property.
Please be advised that the State Environmental Code, Title V, Section 310 CMR 15.301
(3) states: "the condominium association shall be responsible for the inspection,
maintenance, and upgrade of any system or systems serving the units, unless otherwise
provided in the governing documents of the condominium association." This section
further states: "... each system on the facility shall be inspected at least once every three
years and all existing systems shall be inspected by December 1, 1996."
Therefore,the Cotuit Inn Condominium Association has been in violation of this
provision of the State Environmental Code for eighteen(18)months.
Please make arrangements to hire a private septic system inspector and have the septic
system located at 923-925 Main Street Cotuit inspected within thirty (30) days of your
receipt of this letter.
Sincerely yours,
Thomas A. McKean
f,Z 348 -659 96.5
Receipt for
Certified Mail
0
No Insurance Coverage Provided
UNITED ST11TE5 Do not use for International Mail
POST<L SERVICE
(See Reverse)
M o
Of
T
t Street and No.
to
P.O.,State n ZI Code
CPostage
M
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O �
LL Special Delivery Fee- -
Coll
O. Re`R,6t`e'd'Die`]i ery fee''
1 A196 r Re'ce`i'oSVi Wnb9
to Whom&Date Delivered
Return Receipt Showing to Whom,
Date,and Addressee's Address
TOTAL Postage � r�
&Fees J
Postmark or Date ,,I
1 �4
' STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
-CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address LA
leaving the receipt attached and present the article at a post office service window or hand it to
your rural carrier(no extra charge).
SIC
i2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Q
M address of the article,date,detach and retain the receipt,and mail the article. rn
3. If you want a return receipt,write the certified mail number and your name and address on a
return receipt card,Form 3611,and attach it to the front of the article by means of the gummed
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT
REQUESTED adjacent to the number. C
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, 'co
endorse RESTRICTED DELIVERY on the front of the article. E
`
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If -4..
return receipt is requested,check the applicable blocks in item 1 of Form 3811. to
a
6. Save this receipt and.prnsgw it-if you make inquiry. 105603-93-B-0218
I {
4
Town of Barnstable
• Department of Health, Safety, and Environmental Services
BARNWABM
Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-790.6265 Thomas A McKean
FAX: 508-775-3344 Director of Public Health
December 2, 1996
<.Maureen.Cullen.
W. .Patrick Len_tell
:10 High-,S-tr&et-y
Boston,`MA 02110
Re: The Cotuit Inn, Main St., Cotuit
According to Title 5, the State Environmental Code, Section 15.30(3), all septic systems
connected to condominium units shall be inspected before December 1, 1996 and at least
once every three years thereafter.
You may not have been aware of this requirement until now, therefore, please feel free to
give me a call at 790-6265 if you should have any questions. In the meantime, please
make the necessary arrangements to have the septic system(s) inspected. Attached is a
listing of DEP certified septic system inspectors.
Sincerely yours,
Thomas A. McKean
Director of Public Health
Vv�
J
` -
Z 348 659 ' 955 -
Receipt for
Certified Mail
e No Insurance Coverage Provided
IIMTED STATES Do not use for International Mail
�usE�
(See Reverse)
Sent to s
O)
L Str t and N
to
P.O., at I de
O
40 Postage
Go
S Certified Fee
O
Special Delivery Fee
a
f!1(If,�es{cicted iDe,i"I'yeiy,.ee
�,eoetPt- owirrt�
..to-Whom&Date�Delivered
Return Receipt Showing to Whom,
Date,and Addressee's Address
TOTAL Postage '
&Fees
Postmark or Date %,2—
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address
leaving the receipt attached and prasent the article at a post office service window or hand it to
your rural carrier(no extra charge).
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Cl)
address of the article, date,detach and retain the receipt,and mail the article.
t
3. If you want a return receipt,write the certified mail number and your name and address on a
return receipt card,Form 3811,and attach it to the front of the article by means of the gummed g1
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT
REQUESTED adjacent to the number. OO
00
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M
endorse RESTRICTED DELIVERY on the front of the article.
o�
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If u�
return receipt is requested,check the applicable blocks in item 1 of Form 3811. d ,
6. Save this receipt and present it if you make inquiry. 105603-93.8-021e ( -,
SENDER:
V ■Complete items 1 and/or 2 for additional services. I also wish to receive the
H ■Complete items 3,4a,and 4b. following services(for an
m ■Print your name and address on the reverse of this form so that we can return this extra fee):
card to you. d
■Attach this forth to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address V
d permit. ry
y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery
■The Return Receipt will show to whom the article was delivered and the date C
C delivered. Consult postmaster for fee. •�
0
v 3.Article Addressed to: 4a.Article Number d
C
E 4b.Service Type
0 � ' � ❑ Registered iff Certified W
rn
'~ ❑ Express Mail ❑ Insured
cccc ❑ Return Receipt for Merchandise ❑ COD
��'
a J 7.Date of Delivery 0
Z O� lal A I u —
p ,5.Received By: (Print Name) 8. ddressee's Address(Only if requested Y0
W` and fee is paid) t
oc
g ` 6.Sign t (Ad ressee or Age t) `
H
X
Ps Form 3811, cember 1994 Domestic Return Receipt
kawww
UNITED STATES POSTAL SERVICE 00• M4 .— First-Class-Mail )
G N "Postage-&-Fees-Paid'
w PM u-SPs—_._____.-._
o -Pe"-"'— fmit-No:-G 10---
F nF( ro'.
• Print your name, toddfess, and ZIP Code in this box
"0210 Depot
;OwT of Barnstable
BOX 534
"yann►s Iviassachuselts 026M
`.i•
f,
Town of Barnstable
Department of Health, Safety, and Environmental Services
r BAMSTAHM +
"AS&&639. Public Health Division
367 Main Street, Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean
FAX: 508-7 7 5-3344 Director of Public Health
December 2, 1996
DZVO
EC
1 y9s
Forest A. Daniels, Jr.
30 Nickerson Lane
Cotuit, MA 02635 d ,t
Dear Mr. Daniels:
Re: The Cotuit Inn, Main St*; Cotuit '
According to Title 5,.the State(,Environmental Code, Section 15.30(3), all septic systems
connected to condominium units shall be inspected before December 1, 1996 and at least
once every-three years thereafter.
You may not have been aware of this requirement until now, therefore, please feel free to
give me a call at 790-6265 if you should have any questions. In the meantime, please
make the necessary arrangements to have the septic system(s) inspected. Attached is a
listing of DEP certified septic system inspectors.
Sincerely yours,
Thomas A. McKean
Director of Public Health
I-PRojwTlu=T,oN-,A,S",,.,:I?�loi,f,,.T,At N S T A L Ej JMA,
X/
r aOi NO.
sT SHEET F . J
. _ LOCATION MAP .. JZ ''7` I . 0