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Home My WebLink About0151 KNOWLTON LANE - Health 151 KNOWL7OjVl.LW,, MARS70NS -MILLS 702-- 181 f 1� TOWN OF BARNSTABLE LOCATION i S � Kai, A `fear) [JA- SEWAGE# 25-1$®k VILLAGE. Wl A a29 f b-0S NJ 15 ASSESSOR'S MAP&LOT/oa 'r 181 INSTALLER'S NAME&PHONE NO. L.S� fZb i61; �C��"iL 77•�•-��7(, SEPTIC TANK CAPACITY Is&D LEACHING FACILTTy: (type) (size) t1 `X 2-`4c GQ1 NO.OF BEDROOMS -,7 BUII, �OR OWNER COMPLIANCE DATE: f S 3�a—� t 3istance Between the: ; J:n,-=Adjusted Groundwater Table and Bottom of Leaching Facility Feet A,vate Water Supply Well and Leaching Facility (If any wells exist ^. >±e or within 200 feet of leaching facility) Feet Edge,q Wetland and Leaching Facility(If any wetlands exist wi&i u 360 feet of leaching facility) Feet Furnished by i . j No.. O m y Fee 3 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mig ool *p$tem Coit5tructiun Permit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 151 Knowlton Way Dennis Carey Marstons Mills Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Service F.O. Box 1089. Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( n6 Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil gravel Nature o Re s ai or Alterations(Answer when applicab e 1 , 500 gal tank, d—box & 12 x 0 F precast leach-field w d tlowlj f & 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 issued by this B arV Health. Signed jai Date/ Application Approved by Application Disapproved for Re follo ng reasons Permit No. I�� — �_� Date Issued ——————————————————————————————————————— .. `✓'1i�j� +�b��, ..,,,,r S„--�t.�,�-�,...s.1 i••�''.Y^✓.^i�- -: 7�... _,....,,�..r�....q+`+�.w.^»y r1,r' _-. r �'.t i... .h� �r No. d r Fee30.QO THE COMMONWEALTH OF MASSACHUSETTS 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for Miqu of *p!tem Construction V ermtt Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 151 Knowlton Way Dennis Carey Marstons Mills x Installer's Name A dress,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic Service P.O. Box 1089 Type of Building: . Dwelling No. of Bedrooms. 3 Garbage Grinder(rid Other C.Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures 5 - '.o.Design Flow"" gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of.Soil gravel ,r Nature of Re airs or Alterations(Answer when applicable) 1 ,500 gal tank, d—box & 12 x3p0 precast leach-field w/3 mod&& hd flow d fuses t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuee/d�by"`this Board Health. Q Y Signed 4�� , i � Dat l / Application Approved by - Application Disapproved forte folio 'ng reasons,. i Permit No. Date Issued h 9� i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal$ystem installed( . )or re8aired/replaced( x)on by W.E. Robinson Septic 5ervlc'or Dennis arey as 151 Kno**ton Way Margtons Mills has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.g4*- e dated Use of this system is conditioned on compliance with the provisions set forth below: l No. � Fee 30.00 i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wi5pogal *pztem Conotruction Verna Permission is hereby granted to W.E. Robinson Septic Service to construct( )repair( x)an On-site Sewage System located at 151 Knowlton Way Marstons Mills 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. All construction must be completed within two years of the date below. Date: Approved by 1t } CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) r I, hereby certify that the application for disposal works construction permit signed by me dated �`—/ concerning the P g ' property located at ® K/l/® r— u/ meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED DATE: I/ LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NU VM IR [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. I Ii T� 3 i 1 oaf �b .000 �s Commonwealth of Massachusetts Executive Office of Environmental Affairs Department Of Nov 15 1995 , Environmental Protection H,TMM". William F.Weld TM OF UN SWIM r Governor Trudy t:oxe a Ssent y EOEA 1" David B.Struhs ! Commiasioner i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ar-nt PART A M Mpg lzin s r//J CERTIFICATION / aeh6'//S Property Address: Address of Owner: Date of Inspection: 1 1 — f `f��'Z (if different) Name of Inspector: W.E. Robinson Sr. Company Name, Address and Telephone Number: W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT 7 �7 I certify that I have personally inspected the sewage dispos l sPsYe� t 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: � Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: w 1, � Date: ///�/— 9 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the 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] �t: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 mores m components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determi ed (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain wiry not) The septic to k is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. T e system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by he Board of Health. (revised 8/15/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)SWI049 • Telephone(617)292-5500 40 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /'� krN/VI/ d-h W,4 u K5 funs 14; Owner: y.,'vlvll,S Date of Inspection: /l—/y-4 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage ckup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or a to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of He Ith): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system reg fired pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(vZith approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS RE UIRED BY THE BOARD OF HEALTH: Conditions exist which requi further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the vironment. 1) SYSTEM WILL PASS UNLESS B ARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE P BLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is wit in 50 feet of a surface water Cesspool or privy is wit in 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS TH BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONIN IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a sept 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 t k and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic t k and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic t nk and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a we water analysis 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• D) SYSTEM FAILS: I have determined that the system v olates one or more of the following'failutp criteria as defined in 310 CMR 15.303. The basis for this determination is identified low. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facil ty or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of a luent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /S/ k0 U("/f"7 W" y M 4t"10"S 1wi//S Owner: 'OLtj►nl j Ga,'t,/ Date of Inspection: ,C; D)SYSTEM FAILS(continued): Static li id level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pum I ing more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of ti s pumped Any portion the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portio of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion o a cesspool or privy is within a Zone I of.a public well. Any portion of cesspool or privy is within 50 feet of a private water supply well. _ Any portion of cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable wa r quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bact ria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria app to large systems in addition to the criteria above: The design flow of system i 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment becaus 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 locate in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water suppl well) The owner or operator of any such stem shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 an 6.00. Please consult the local regional office of the Department for further information. (revised 6/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: K1114-✓17Or1 /19�APS�o�S Owner: D-cr1✓IJ3 G'a,'e/ Date of Inspection: Check if the following have been done: lumping information was requested of the owner, occupant, and Board of Health. Lone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ,,As built plans have been obtained and examined. Note if they are not available with N/A. q/The facility or dwelling was inspected for signs of sewage back-up. "The system does not receive non-sanitary or industrial waste flow _Lr1`he site was inspected for signs of breakout. _ "6 system components, excluding the Soil Absorption System, have been located on the site. septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _LXhe size and location of the Soil Absorption'System on the site has been determined based on existing information or JAZapprrooximated by non-intrusive methods. facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- � Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: at"/S Gae e- Date of Inspection: /�.. �/`�d— FLOW CONDITIONS RESIDENTIAL: Design flow: q& V gallons Number of bedrooms: 3 Number of current residents: Garbage grinder(yes or no):_&,, Laundry connected to system (yes or no):� Seasonal use (yes or no): s✓ Water meter readings, if available: Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of es blishment Design flow. Vings, Ilons/day Grease trap pes or no)_ Industrial Wang Tank present: (yes or no)_ Non-sanitary charged to the Title 5 system: (yes or no)_ Water meter if available: Last date of Zoccancy:_OTHER: (DLast date ofncy: GENERAL INFORMATION PUMPING RECORDS and so/u�rce)of,information: System pumped as part of inspection: (yes or no)LA,1- If yes, volume pumped. gallons Reason for pumping: TYPE OF STEM 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) Other(explain) ` /dr 3tl�g' APPROXIMATE AGE of all components, date installed (if known) and source of information: ' Sewage odors detected when arriving at the site: (yes or no)L (revised 8/15/95) 5 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15�d T1 nUw lam �,A)/ fy//fr5�in.S NI� lIS Owner: 0-Q 1 AjS Date of Inspection:'`^ �— SEPTIC TANK:_ (locate on site plan) Depth below grade: �� Material of construction: ✓concrete _metal _FRP other(explain) a, /,S`'<i 4 0 i Dimensions: f b 'b— 4 te .x 617' Sludge depth: O Distance from top of sludge to bottom of outlet tee or baffle:® Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: 0 Distance from bottom of scum to bottom of outlet tee or baffle: Cj Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) C-lacJ S x J a GREASE TRAP:_ (locate on site plan Depth below grade: Material of construction: concrete _metal _FRP—Other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of Srij tn honour of outlet tee or baffie: Comments: (recommendation for pumpi g, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leaka etc., kA (revised 8/15/95) 6 l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: w"¢y Owner: eOl/'2 Date of Inspection: �l•��'s TIGHT OR HOL ING TANK:_ (locate on site plan Depth below grade: Material of construction concrete _metal _FRP—other(explain) Dimensions: Capacity.: ga Ions Design flow: a Ilons/day Alarm level: Comments: (condition of inlet tee, c dition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distributiun is equal, evidence of solids carry,o•:er, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:( es or not Comments: (note condition of pump ch ber, condition of pumps and appurtenances, etc.) a (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: /5�� , l�/ls�v�Tar1 �` y �✓1,9rS tons /v1il�S Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible, excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: 1, leaching trenches, number,length: f— leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: (locate on site p\n)Number and contion: Depth-top of liqinlet invert: Depth of solids l Depth of scum layer: Dimensions of cesspoc Materials of constructio : Indication of groundwa er: inflow (cesspi,ol must be pumped as part of inspection) Comments: (note co ition 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 o soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 8 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: i�l �ac�/fan 144 S Owner: ,t7,n A/S C a r 6 Date of Inspection: `� - SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER Depth to groundwater:,L'-_feet _ method of determination or approximation: )`s ? I�a f a4 l l�1 3 (revised 8/15/95) 9