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HomeMy WebLinkAbout0300 MAIN ST./RTE 6A(W.BARN.) - Health 300 Main Street/Rte. 6.A West Barnstable A= 134— 009 — 002 y `� TH OF ` SSAC= L S--T= E �F1'ICF' OF E\'�iRO\1IE1T"=� �r r ECUTIV Z t''�_ --. E r' , 1 EP RTMENT 0 E-NTv O l-IE'\�T_zL PR0TE( T'_0X TITLE OFFiiCs AL Y SFECTION FORM-NOT FOR VOLC_!T<A_RY ASSESSME- TS SUBSUR—FACE SE k AGE DWSPOS AL SY SMM FORM PAIZ T . - - - " --- CERTIFI C AI O - - ! l! Property Address: �� / t el - I Oc) 6t Owner's lame: d G✓i11fal 47 O.i-ner's Address:_ 0 Wes 0J,66 Date of Inspection: \acne of Inspector: please print) Company lame: VI 0— 1E G/Y `tlailing Address: o 610A1 S 14114 va6T Telephone Number: CERTIFICATION ST ATE._1E_NT I certify That I have-oersonalll 111spected the S wa7e dis-,)oral system ai this au—drtsS and ha the i^ o i- at 0 pZ):Led f below is true, accurate and con ple-�,as Gr a ti ofthe inspec o-n. The iris—L'.cdcn,vas p.,ifonnl_u Dai,.l_ o.___lV training and e-xpeaience in the proper L.Irici or_and maintenance of on site sewagep disposal sys°e,__s. F am a DEP approved system inspector pursuant to Section 15.340 of Title "(310 CNIR I5.000). The s.stenl: I rasses Condir_onaily Passes — Needs Further then E:°a.luaaOn b;`thie L ocai Alppro'.'.n �ut1o't I airs Inspeetor's Sxignatnree _ 4�� Date: / 09- The system inspector shall submit a copy of ties inspection repon to L'e yppn _A,.: ro__ ;Scar o DEP) wiihin N days of corn)Ietillc this iI Spection.Tithe s,,"Stem is a shared svS'. _-:Or_aS u G _thel 0 gpd or greater, the inspector and the system o%,,nc-shall submit the reporc to the a t re:;,;o`-,_a1_ offfice DEP. The original should be se :to the s -stem ov rer and copies senr to the o,.;er, aop_i ao e. _ � -: _ a authoriL v. Notes and Cornments iz ! "' This report only describes conditions at the time of inspection and order the conditions of:use at that time.This inspection; does not address ho-w the system will perform in the future under the same,or dift r r- conditiops of use. Title 5 Inspection Form 6./i /?000 _ pace t Page 2 of I 1 OFkIC1AL- I\SPECTION EOI-lI—NOT FOR VOLU T_-2Y ASSESS-MENTS ' SUBSL RK-kCE SEWAGE DISPOSVV_ L SYSTEM J SPFCTro'ti Fop—XI PART 1 A f CERTIFICATION (conrnued) Property-Address: 3�� G I H �� r,�es ��o►r e_�/�i� ©a 6 6F Owner: /��4; v*? yr Date of Inspection: IZ6 La 9- �i Inspection Summary-: Check; A,B,C.D or E i lULNVAYS lion complete all of Section � _ p � D A. Sys Passes: _ I have not found any in-foitnation which indicates:Pa a v� ' rc d=cccriD in i r. f the fain.. crite=a -�.:�d 15.303 or in 310 CNIR 15.304 exist :-`.nv failure criteria not evaivated are indicated below. Comments: i B. Svsteni Oonditional1v Passes: /I/ One or more system components as described ir_the"Conditional Pass" section need io he repia ed or repaired.The system, -:_pon con.pletion of the replacement or repair, as approved by;lie Beare of health; vv�il pass. Ans«er ves,no or not eterrriined(Y,lv`;NM in the for the foilo�rina siatenients. If `rot deter nir_ d"please explain. The septic talLk is metal_ and o v er 20 rears old" or thee septic tank (v hether.lei 1 or n0:) is Su t'ai_l� unsound, exhibits substantial infiltration or enfiltration or tanlc failure is i_m,minent. 4�,Ysteill 'ill�aSS `_ D20 !01 f 112e existing tank is replaced-mith a complying septic tank as approved by the Board o-Mealtll. *A metal septic tank vvd11 pass inspection if it is structurally sound;not leaking and if a Certificate of Comp'l ance indicating that the tank is less than 20 years old is ava lable. ND explain: Observation of 50 vaCe ha.0 Z r or break out or high Static Rater l ei in file d'SLibli t0" bOl Luc t0 L-ro Pn OT obstructed pipe(s) or due to a broken; settled or uneven dis-ribuncin box. Svster171 W Il p ass insrect o i ::- appro,ai of Board ofHeaith): broken pipes) are replaced obstruction is ren:o.-ed distribution box is ltv l,d or replaced i� F 1`'O explain: , A The system required pumping-snore tPmi 4 times c ear due to bro_c-7 or ocz t-- _v ni i pass inspection-i(with approval of the Board of I_ealln): broken pipe(s) are re---,laced obstruction is refro�ed \D explain: Page 3 of I i OF ICI_L INSPECTION s ORM - gOT FOR VOI.C'_TAW ASSES.SALENTS SUBSURFACE _AGE DISPOSAL SYSTE T ENSPECTIOIs FOPV'+1 PART A CERTIFICATION ERTI 'ICAIION(contiruled) $ It !, Propert` address: J�. i"Y�/✓I Owner: / j Date of Inspection: o Q9 C. Further Evaluation is Required by the Board of Health: Conditions exist, hich require further evaluatioIi by the Board of health -i crd.'r to det:=r!e is h. �M: is failing to protect public health; saf ty or tine environ.ient. 1. System will pass unless Board of Health determines in accordance with 310 C VfR 15z.30 3(i)(b) that the system is not functionina it,a manner which will protect public health.safety and the environment: $ Cesspool or privy is v,ithir_50 f et of surface v.:zter — Cesspool or privy is? t'rir_JO fee`of a bordering vehetated :T Hand or a salt irwr:n 2. Systern will fail unless the Board of Health (arid Public Water Supplier, if any)determines that the sN stem is functionina in a manner that protects the public health,sa=ery and enxironment: The system_has a septic tarlc and soil absorption system(SAS)and f"ie S--�S is .:i:llir_ 100 Lee t of a surface water supply or_111"butary to a surface«rater supply. The syste._i has a seo:ic -a---k and, SAS - S v Z f - ;.t aie— _ _ :i and the AS is iti_-;n a ore ' o-a ou^l.c �=r The system has a sept7c tank and SAS and t e SAS is viith-,n J17>.-et of a J i`3`e rate'supply ell The systein has a septic tank and SAS and tLi e SAS is less than 100 feet but 50 i`et,t or more troy_a �€ private water supply well".\-lethod used to determine distance **'I his system passes if the welt ;eater analysis.performer at a DE ccnir ed tabor azo7 for coiilomn, bacteria and .-olatile organic c mpo- d c. that the well � - -p h =1;o nic o .sn s ii:d ales I,=ee o� - oI'u._or ;.o t� a z�J the preser_ce of ammonia mi o_en and nitrate nitrogen is equal tc or less than> o"rri r O`."idcd t:at r0 ON er failure criteria a�e triggered A copj o:Ftl?e anFi_etj i:nst be a`aCred tG Piis fJ it S 3. Other: co 1 1'a__ . of 11 OFFICIAL INSPECTION, FORT— O T FOR VOLLTIN'TARY ASSEa51fE'iTc i SUBSURFACE SEWAGE DISPOS� _SYSTEMIN C - - PART A CERTIFICATION(contUTa'-d) Property Address: 3� �Gj/ v? � -- ZI Qyi-ner:_i I e,V-7 _ Hate of Inspection: 9 D. System Failure Criteria applicable to all s,stems: You must indicate "yes'' or no Lo each of the foiiot,. g;:ar all inspec-ior_s: Backup o=sett age into fac`-r- or syste ? o Oren:due t0 o`erl oadleal or C'ogge i s o r- Onol Discharge or poridi?g of efflue , .o the sarfa.ce of the trretlnd or surf_ _ .ater_du, to an a r, d2d o: ogged SAS or cesspool Static 1C1L:d level in t] uISt2?�;_tion box above outi•et?nt%ert due to ar-O r OaG C Gr 10z 'G J �.OI cesspool !✓�.iquid depth in cesspool is less than 6 belowert or available- o:U-me _s Te L n _o IRequired pumping more than 4 tinges In the last tear NOT du, to cioGzed o_ obi rucL...a;,I,ei Sl �Mimes pun-Ted Ily porT10 1 Of the SAS, Cesspool oI p 7Vy is below high ground water, ai o . t/ Ar_y portion of c sspoci orp_i-.7 is vviihur 00 feet cfa surface water_upp' o:trbutart to z s r:a;e /water supply. I .ariV�Oirt1Ci?Of a CeS�v001 07 rt.�'v 1S t?ithli a LCne '. O a plli+ C .�el. portion of a -cesspool Or D is within OC feet of a p 1,at--water l a�r� p1 t.;� 1. Ary port-ion of a cesspool or p y :s less than 100 feet but g-I-eater-ran 50 f.et 57om a piiva re z.'arLr supply -eI' t%ith no acceptable water qualliv analysis. [This sz stern passes if the well water analvsis. performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the isrell is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.pro-,ided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] A/O_ (Yes/No) 1 he st-stew.faits.I have dete tdni ed that one or more of the ai`•c e failure c-_:cr.a,._i!st a, described in 3 10 C1'1R 15.30J.therefore he 3} tem fa 1 The Sy to GS _er S+iOt ?CO tact 1 Oar C'_ Health to deterriune what will lop-necessary`o co7ect fhe failu-e. E. Large Systems: To be considered a large system the s`vstem 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 foliotk°inr: (The f011r %ing Criteria appl} to farce systenns In adds ioI?to the Crheria a,nve) :es ' the system is :%lih n 4400 feet Of a su-,face G inl.ng R•ate7 supply , the system s within 200 feet of a tributal y to a surface drml ,hater s , . — the syste r is located in a nitrogen yen -live zrea'"i_.fe In _heaa t�r voe i �- one II of a public:traTer supph el I - - - If you have answered"yes"to a , t estior Sec q it Ltol `' 1he St stemT is consld-red a sl ye in Section D above the ia_ge sy�t tLt~as P ` significant threat i fail d. The Ot Ier Cr op a or Of a::V a G hrea under Section E or failed'under Section L`s fall upgrade .ne �I5. 04. Tne systet :ott'owner should s r7 - _ contact t'�e.at) ropn_ate rea onal oft - - - -ce r Page of 11 OFFICIAL INSPECTION FORM—NOT FORN.'OL '\TARS' ASSESSMENTS SUBSI;RF'AC:E SFWAOF DTS'P0SAL SVSTF.JNI INSIPECTI0N FORZI PART B CHECKLIST Property Address: J AG r ki J Owner: 1✓/1!I G v�j aa.�� , Date ofInsp?ction: Check if the fol.Ctiymg have been rione. i 21w must i:(Kate ;�yes"or "no 7 as io eacl- Ci the foiiO t ing: Pumping infcrn-iation-Nt'as presided by ire o.tne-, occupant. or Board ofHealtli i Were anv of the s:stem components purnpec ou in the previous?vo vveeks Has the systeni received norn.al_o1=:s in the prfvious t.-vo N eek period Have iatz.e volumeS of,�'2ter be:n.ntrodticed tc i1-System recently or as pa-o L11S inspecrion v ere as vti'_iT plans Ct t e syste77TI obtained and ZYai7LneC19(If fhey v ere not a�.'a.lable _note as Ni',­", Was the faciiiry or dwelling inspected for signs of sewage back up the site inspected for signs ofbreak out Were all system components,excludin g the SA-S. located on si.te `? Were the septic tank,manholes uncovered,oper d, and the interior. of the tangy:irs�ecteci for t c c,:10:-_ of the baffles or tees; material of constntcLion, dimensions;depth ofliTrid. de.ptz ofsludge and depth of scum Was the facility o vvfiler(and occupants if differe;lt from c-�,ierj provided w4tl_info-rmation on ffi:7,toner maintenance of subsurface se-v ase disposal systems The size and location of the Soil Absorption System(SAS)on the site as been deterr~ined-eased or_: Yes no l/ Existing i.aformation. For exa= e, a plan at ilic Board ofHea .h. Detennined in the field(if any of the failure criteria relates to Pa_�C::S at__suea. is unacceptable) (310 C-MR 15.3,02(3)( 11 P I t I Pare 6 of 1 1. OFFICIAL INSPECTION FOR.1I—NOT FOR VOLI;N ir-A-RY_SSE SSA ENT S SUBSURFACE SENVA E DISPOSAL SYSTEM I- SPF-CTION FOR-AI PA_R TC SYSTEMI INFORNNIATION y Property Address- �©� Owner:_ Wi !q s^?f Date of Inspection: O FLOW CONDITIONS RESIDENTIAL t Number of bedrooms(design): C�L �Jumber of bedrooms(actual): DESIGN flow based on 310 C'%4?, 15.20 (for example: 1IQ g_cd x,'ofbedroems): _ Number of current residents: U� Does residence ia-ve a garbage amder(yes or no): Is laundr:on a Separate sewage system,(yes or no):�VO ij'i_"e s separate---Spection ie�iiiredl Laundry system inspected(yes or no): Seasonal use: (yes or no): 2S Water meter readings. if available (Iasi 2 vears usage(gpdY _ Sump pump(yes or no): .� Last date of occupancy: CONEvIE'ROIAL/I DLSTPdA-L Type of establi.shnient: _ Design flo'cv(based on 310 0MR 15.2)03): :Basis of design flow{seats%personsiseft,eic.): Grease rap present(yes or no):_ Industrial waste holding tank present(yes or no;;:_ \on-sanitary waste discharged to the Title 5 system(yes or no):_ Vlater meter rea(ungs, if available: Last date of occupancy/ase: OTHER(describe): GENERAL FNFORj .-STIO'ti Pumping Records 00�— p �cev Source of information: Was system pumped as_)art of the inspection(yes or no):�_/'✓' If yes, volume pumped: gallons--Hovv was guan-ity purr_ped detennined? Reason for pumping: TYTi�F SYSTEINI (/ Septic tarn; dis-ibiitloP_box, soil absomtion systeni _Sinsie cesspool Overflow cesspool —Privy _Shared system(ves 0r no) (if yes; attaci7 previous>iS�eC ii0n 7ec0rds; 1 a i # lnnovarive'Alternarive techrio1ogv. Aitach a cope of the 1 went operation a=1d ma•r , i_.. :_T'ria . J na_a obtained from systeir_o«:er) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all compon PtS, date Lnstalled(ifkno.N i?)and SotLr ?/0 1='f0istat?0 Were sev,7a2e odors detected,when ar iving at the site(yes or ,o):AV f -Page 7 of 11 OFFICIAL INSPECTION FORT —'--N'OT FOR VOLUNT_A-RY ASSESSMENTS �_ ILNTS SF7BSI;PFA.CE SEENAGE DISPOSAL SY STEA- 1 E SRECTIO tvt��I PART C SYSTEM E-,' FORNM TION(continued) f; li Property Address: C7,90� e-Ft Owner: Date of Inspection: I,?IiILDING SENNTR(locate on site plan) Depth below grade: -Materials of construction:_c!/ ant Lren _40 PV"C_other;explain): i! Distance from private v.-ater supply well or suction line:_ Comments(on condition of pints; venting.evidence of leaka;e, etc.): SEPTIC T1`+K: (` (locate on s`e plan) Depth below-grave: Material of const ucr:'on: _concrete_petal_fibeglass rolveCnvlere _other(explair_) -- _ �. If tank is metal list a`e:_ is age confirmed by a Cerd cafe of Corr_Hance(.-es or r_o): (a Mach a col -o f certificate) n�� �q//�� -- -- Dimensions: Sludge depth 41— G v Distance from top o sludge to bottom of ordet tee or b_,ffle: Scum thickness: of / // -- Distance from top of scum to top of outlet tee or baffle: i Distance from bottom of scum to bor�c�o tie!to-r ba _le: Howe were dimensions determined: m ! _ l OrLmenI (on purnpirig recorrin-enCations"lrlet arty o et':ee or baffle conQifiion, sink_,ra" ' ear,' liGcaQ le,'h as rely to outlet invert, evide-ce of leakage; etc. / GREASE TRAP: locate on site plan) Depth below grade:_ ' ! Material of construction:_concrete_metal_fiberglass nolvet_hylene_other F + (explain): Dirnenstons: Scum thicknes : Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bortom of outlet tee or haft=e: Date of last pumping: CorrLments (on pumping recommendations. irlet and outlet c.e or baffle condition,st t;__r r_± as related to outlet invert; evidence of leaha2e, etc.): Page S of 11 OFFICIALINSPECTION FOR-7vR-NOT FOR S'OI_LIT_�RY`ASSESSOIENTS 1 SUBS t7RFACE SF`VAGE DISPOSAL, SY"STEAI INSFECTION FOR-.NJ s RI I� SYSTE I INFORMATION {contiruedi Property Address: Owner Date of Inspection: (, v 9•- x TIGHT or HOLDING TANK: //,�(ta n�k r,usl b ca reed at time of_nspectior._)(Iecait on sate 1ar_) Depth below grade: Mate ri '__et1alofcons�:uc io.1: :Gi'. a Dimensions: --- --- Capacity: --- —._. ---_r oils Design Flow: ---- — lions`dav Alarmpresem(yes ov iio): tl' AlarIn level: a tai n] in v,,crking order(ve-s or no): Date of last pump=:�=: Co=ents(cord:=:on o alar:n and f_+oai sovirches. etc.): DISTRIBUTION BOA: Of> resent must be open ed)('ocate on s__e-lan) Depth of liquid level above outlet invert: �/0/✓''�A Comments(note If box-Is level and distribution to outlets equal. aIl�evidence of solids care over. an- ev de11Ce of leakage into Q o box, et a):Love l gcy!cc - PUlIP CHAMBER: '" ().ocate on site !Dian)) Pumps in working order(yes or no): 1 I Alarms in working order(yes or no): Comments (note condition of purnp chamber. cond"non of pumps and app_,rtenances, etc.): i k iI yy J11 i, ! I ,u '41 Page 9 of 11 a OFFICIAL INSPECTION I ORR_1'1—NO NOT FOR VOLUNTARY _ASSESSMENTS SUIBS1J A&CE SEWAGE WSPOSAL SYSTEM INSPECTION FOR_:I S STEA1 li'I7FLrR-'LAtIO (Con-cinu-21') Property address: 4�/.1 -f-—,/— eS s?-�/e, �,� kI Owner: �.✓��/lGIV S Date of Inspection: v/6 SOIL BSORPTIO\SYSTEl1 (SAS): (locate on site plan,excavation not required) if SAS not located explain �Oli : T. �1 Type leaching pits: number: _ leaching chambers; number: leach�alleries, number: cuing trenches. number; length: leaching fields, n,lrnber, dimensions: �Jx C2 D }C overflow cesspool; number: innovative/alternative system Type/name of technology: Coin hems (note condition of soil, signs of hydraulic failure, level ofponding, carnp soil, condition of- ertetanon. oz- CESSPOOLS: cesspool must be pumped as,par of inspection)(locaie on site elan} \umber and configuration: _ Depth—top of liquid to inlet inyer: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: _ Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of liydraiilic failure,level ofponding. condido- of vegerarion. etc.is PRIVY.:o� (locate on site plan) Materials of Construction: Dimensions: — Depth of solids Comrnents(note condition of Soil, signs of hydraulic failure. level ofpondin`, cor! aio- I 1, Page 110 of i i OFFICIAL INSPECTION FORA-1—,NOT FOR N70Lx'\T-A-RY ASSF:SSAIENTS SUBSURFACE SE IV_SCE. DISPOSAL. SYSTE:VT IN SPE CTT0N FO RAI I{ Y',RT C SYSTE-Al l INFOR: IATION(con ni ed) Property-Address: ���/' �/17 Owner: f a dw S Date of Inspection: � Q ` SKETCH OF SE`'i'AGE DISPOSAL SYSTEM Provide a sketch of the sewa`e u sposal sysiem inc lludiiig iles to at leas-r':,'0.ennanZni r e_tti ce landmaTis or benchmarks. Locate ail ..ells : iihi;l l 00-Feet. Locate where public ivaier supply enie-S fli=buildim F �t s � Dell i /j fC/Y ! r i r / j a 141 —L�o Tart„ I� Paae 11 of 11 OFFICIAL INSPECTION FOR-1—NOT FOR VOLUN ARY_ASSESSMENTS 'SUBSURFACE SEWAGE DISPOSAL SYSTEMI INSPECTION FORM SYSTEI-M ENFORMATIO (conanuecl'i Property Address: Owner: 'r 09 Date of Inspe tioi :_ SITE EX_-,0'I Slope Surface water Check cellar Shallow v ells �stimated depth to ground ��ate. �' fee- Please indicate(check) a l meTho'us used io determine the hint:--Tound:vae?r el 2non: Obtained from s«stem design plans on record-if heckeci, date of design pan re,iew ed: Observed sate (abutting nroperty obsen7ation hole V iihir: 150 feet o-SAS) Checked u-ith local Board of Health-explain: Checked with local excavators. installers-(attach docuintn tation) Accessed USES database-explain You must desc.r 5e' vv you establi-_ ' the high;r and:, ter elevation: i 0 0✓? p /PSG le I� , J a C1 No. C=7, 2 t Fee I,.- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for �Digogar 6pztem Con0truction Permit Application for a Permit to Construct Upgrade( Abandon(A116Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address, d Tel.No. 3/? Assessor's Map/Parcel hw 1 ti �J/-) Installer's Name,Address`,and Tel.No. a — _—009, 3, Designer's Name,Address and Tel.No. Type of Building: 54 brio Dwelling No.of Bedrooms Lot Size �'211 ) sq. ft. Garbage Grinder (A ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) I'-,-6ja r,8,0, 41% ,A dA, 1,y r �C�u r+&" Date last inspected: AC V 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 lace the system in operation until a Certificate of Compliance has been issued by this ar off jalth. Signed Date 07 Application Approved by Date Application Disapproved I Date for the following reasons '� Permit No..l W 9" 7n2 —Date Issued �. No. is m( o Fee 1 s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pp.Yicatia for -Miopoml �&pztem Con.5tructiou Permit Application for a Permit to Construct O Repair( ,) Upgrade( ) Abandon(.Complete System ❑Individual Components r Location Address or Lot No. � ���t`� °r!„;. Owner's Name,Address;and Tel.No. uh" '3(c,Z 41 3 3/ z S,A.ssessor's'Map/Parcel t3 _00 _G P Installer's Name,Address',and•Tel.No. y Z,`I ) Designer's Name,Address and Tel.No. i7'ZG�i r� Type of Building: �� Dwelling No.of Bedrooms Lot Size -71 S sq. ft. Garbage Grinder 00 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title i Size of Septic Tank' - Type of S.A.S. Description of Soil + { � Nature of Repairs or Alterations(Answer when applicable) F3t �-- '.,(­;,-,c-1c)rN ; n c., d/Uu e;1 c,V 'Xll�+L'1 • l Date/last inspected: 4, UU 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 Certificate of Compliance has been issued by this Boar of ea X � lth. _ Signed � Date 7 Application Approved by Date Application Disapproved by: a` Date for the following reasons Permit No. / ————, —Date Issued s ————————————————— ------- THE COMMONWEALTH OF MASSACHUSETTS sz V' N46 BARNSTABLE, MASSACHUSETTS r Certificate of Compliance _ THIS Vby CERTIFY,that the On site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( I 1 _ at /'1 Q has been constructed,in accordance - with the provisions o�-/f Title 5 and the for Disposal System Construction Permit No. ���� " dated 8 U - Installer Designer 1 #bedrooms Approved design flow �/� //} gpd The issuance 91 of t /s permit s 11 not be construed as a guarantee that the system w'+}I-firnction as designed.1/ q c Date �[� Inspector �10/ A IIr�s '! ---- - -- —j---- — ---- ----- — --------- No. 00 Fee THE COMMONWEALTH OF MASSACHUSETTS 3 PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigoml 6p!gtem Cow6tructiou Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 560 � e - and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: C+nstruction must be completed within three years of the date of this fmqm Date Approved by V ROBERT E. BEARSE 4k P.O. BOX 477 WEST BARNSTABLE, MA 02668 TEL. 362-3303 (MASTER'S LIC. 7772� DATE DESCRIPTION AMOUNT D } d 16- n�_ �1J ._ OF 1 DEPA_£T lit '' —_ - - 1 r� � OEFICIAL. IeSPECTION FORM NOT FOR VOLUNTARY a`-i fr SUBSURf-SCE SEE>-AGE DISPOSE SyS-PE:zr E- I T{ CE.RTIFICATIC -n--. address: �00 ���� S7 G,9 _,.er,4 z Via_1e: oa.66i?to . e., t- — _T _r Owner�s.ad dress: _L�o 4Ale-s Q � f s e ,4 Date of in spection: Name Of 2nsPector- taiease print) R✓K �o /�B��. "ladincr address: 776-7 L e,-r s,i, pa 6 6? Telephone N umber. CERTIFICATION STATEAIE�T �- 7 c f I�c i Sonaiiv.ns Zct'Q he c`r7a2= 0$24 c'i C` ^- -- -- -_ - _ - Id e X D "i __"� tar i c:z4 i - s appro Ed C.:jnr)7 ^,sr?CrQ.` C,z +- l- o^ _c n am a F Se ction C' _ .. _ }s' �et_Lr" •, �^'s— � _ �u �• fi' ` 0 z czs "Ina" _ages Inspector's Sisngture: h Date: / v r- V�';''s an.' ...` Cr . di inns of use. u "�t lI ill perfor rt it the r1 , _ Qt r--C INSPECTION FOR-1 1—NOT FOR X U T SYSTEM LNSPLEC�TTO-N" FOR-A! _ PART A CFR-IrIFI',—DTI® P-Ope'i. _dfi,'eSs: �2619 J 7' Date of Inspection: ? Inspection S;:irma; Check A.B.C.D or E '� ��. AI- �.S complete all of Section D A_ System Passes: Or Ir Comments: B. Svstem Conditionally Passes: O or Y-S- =10 o_-eT C'etel___ne ti'.\ND, T se sic _2r -` =ete any c e-20 d*n — O_ r `C-a`,S 'A 1: L 1 �� _c LLt u�� _ ) - on. f .a v of � I.�C n_ v.._. _�_�.e'iLZ^C_C^.''. -_ G stnc 07 of Z- v_ B(`C_._ 1 e c -o:-a _. :ere IiS? . SLBFS�?-RF.-kc-E S1 3 ._ C I37S� PART cA iATIF C 1 IO - `C'--- -` pope:-�E -Address: / ��10 �Gi�✓J �f— 0--ner: Date of Insaection_ D C. Fu"`i er t.al'uation is Required h�-the Board of health: ,/ `cn el.e a La-oa cue Boa-o -- --- - - -t. L. S:'stem,Fill c2sc :li�Sesc BrJcrtl- 3f dlealt,''3 Oeter..lees r a-- s - tern is rot i 4 ,L i " t iO1 r_ n a manner l,c;: Prates:�uJlic hea€th. sa: - — - Ces, 0o- 3. Srstem will fall unless the Beard of Health: � s �tpi ,C rC - alct ,aP_C.�ul7iiC Water Su��3lier. _r aIl r L:"] Es t " r C_ i_ rlg In a -maP_^er that yrOiects the pubiIC heait�, z2fety and - - nas a Se-?_C -=^aria=G='-ab_C"'C SYS`.=r 4 Ql - -.. 'ace "%aver ^i�;0- ?O- - - -- - -- - •-- - _ _D a �:se` o� -------e S }srema ;es =___�e water am?i;;ss. =o_=t.ed ai a A r'Q``p`n r 0 a-_� C^-,o�d _Il 2 =a=_ .0 Aj r,✓ _ 6e a , OF I kI INSPECTION FOR:1,1_NOT FOR OZL NT_-k—Ri AS,E-SUBSYUR FACE 3, T3f� �;S.1L S�S .IZ- �F cr c31 <�r�� PART t i-o:ert--_address: / /�- 0--,ner: �/i! rr ✓tiff Date of inspection: 7 0 D. S stern Faiiure Criteria applicable to all systejac_ tc Ji2t7 :i.0?box_ 1 C - ^ 7-1 U!--i _:are _>s u_ a s 7 v a7 C i _ a -_I."�,:_ c,,Ssuioc,O - -- --`- C - ^- 0-a cesspOO,Or v S o- On cf a ccsspoci Or P7nivv,S 7css n�i _ - --c= ',o _ - _ - - -— sll D '" e!" vi h IlO ZCO = n`ZtP. ?a -= Cp,a -C d- 2^2t;S2s. "This s�'ste 2?D255e:If _'__ -' -``- the eli 2 r performed aI a DEP certified i2b0ratorr,for coiifor m bacteria and volatile Oran C CCi;:D^ iris'P_dicateS that the?}ell is fret from poLu',91-1 from that faci,; -a?d the:,resence nitrogen and ni-trace nitrogen is equal to r less than,J pi.n,pr`) ided t ha`--0 C- Er e c-:eria -e tri--ered. A copy of fire anai,-sis must�- attached to ILis form,..': ----- , F- `s.No) 'he sj stem falls. ii.: - - - n - 1 =;UGC =..i•`�i -`- _ u AC` t1 ;� - �/'..; _ lit _ai_'..�.. _ _ -- -_ eSC C !n__ C- P, :?..:1,�_.'h--`efbre t�=ht H--aithh to ,c,--Ja=b La_de�:. E. ar?e S steams: To be considered a !2r,e s,.steSim the st-ste t>e1-_ f rn must a acil � ,. tf a desi��7,, - - - -. uQ _-C- -C - -`a a? - _�� _G co - _- r J rr - — - __�J17 n, - - - -- 7- ' ex- r- l iJN FOR -1 -NOT FOR VOL NT�R' BS z RFACF; SFzI AGr, - DISPOS_>7. s >TEAT °-1-1 - 'PRT B CNEC-fals T. F:ODer Address: ©O /�R Sf— cs o«-per: C✓�'ll���f DateofinsPect____ 7 O Ci_ c t _- =c i c,;;_ a v _ cn "-o,must - - Has _,*'le ` ` s - ` °=u.:-lo` 0 . --e-bee,=_,er _. -- -- - - _ ^ ✓ \ ack r.- of_ h- _S es r_3C i e size and location of the coil Absorption System, (SAS) F Oa 3_C-41- jNSPLCTIO\ FORA1—NOT FOR ',-OL -\T_A-RY- SI,-RSL RFACE SEiz_ c a �.GF: aRT _ -oDerr-Address: h Date of Inspection: LOzz C4�DITI��S RE SIDE'TI AT v o z, __.. _-C — �Oec a c_-v,a^c gr de_ ves .i se: /Va= ==r', e C`JN ZN"IE RCI-4L'IND US TRZ AL �aS-S O"...ec;y_ =.0 :SOBS;` — _r G: Ce -- L.d. - a -,-aste _C'c-<-ark '.^-CeCy :1-1 T•- -- - =C - =C e e�e - ,o as ca,e C`CCc- OTHER - GE:t`ERAL I:�TORAIATIOD Pumping Records JOli7C.'CriniO ..ai'Ou: S Q t/✓ � T�-p OF \Y`TE `I _ _ P 7 ' - c: � L OEEiCaAL I FEMO\=FOR--N -NOT FOR VOL UN i��� _�:,L��Z_- �c C _ ?C �$c�.�i r a�+_1Gr Z�iSr� ?S.iLsssTE:�Xr:� P Cz=c�� i�rtiti� PART C SYCiEMI'XrOR)a')!IOC Prooer-v Address: -,700 e'S . D--e of:ncpeeiion: 7 p� S--ILDZNG St-l:-%ER::cca c_,sir :a-', :�- �-Oz, - = 171 ---- --- -=akaze. SEP:7.r lass — iT-LLB. . ai __ a� C-0___—_____ c�.," ----'_ -• _ __ _ _— __ _ _ _ D S c�_.zcp , ,S � c vc�c� c_ 20 e�: :..re ei��e-So-�S Ce...__�Lre� �'o/e �✓ w � 7 �✓1 — �r/l B v1 =, e:_ ,SS: _ _ 07 0_:_.-:__ - J`_ _ - - -01 SE . PART C Oj Fropertv dress: .S f— a✓i f Date of i,soectfon: TIGTTT D:_ A a=present( =s or Dale c DISSTRIBL 4I©\ 3OX: (/ k -rese._= - — _����� - � Lee/ 4-1 K-1IF CRANIBER: Li=s - nc n- `- - I ®FrICa_ T INSPECTION FORM—iOT FOR r OLL� - ?P- _iS c.;= :1I t -S B R F_-k' >_E � VV-AGE DITSPOS s L Lys. P.-.R- SYSTEM JN ORNIA T IO •co-_ Property Address: kle -Owner- (,Vt etLl Date o`'nspection: � Q SOIL -ABSORPTION SYSTE1I(SAS): (locate on site elan_ elca�ar�on no, re ;mac _.iu.- i?zc �, 'eac=g -enclnes. er �. /a X rcach--n= r-ids. ms S0/ / CX D? G:solids a:er: G ._ss:�G _ PRIETG 1' �\ O A ICI_ I S ECTIO E-OR11— NOT POI OL_NT `& t`zS -t_ C SE� AGE DISPOSA- syS-r_2q INS,PE: PART C SYSTE:V1 IN FOR_11_ATION Property_address:�©O � f W7 Owner: (Vi 6 to v",f- Late of Trspecr_-oz: p k y j J ` r0 ��- RY ®Fi aCg_ :-SPEC-'I0 rOR-AI—'\Oi FOR i-OI UN—_- 2 _ ;i Rl C Proaer • address: (mot//���, Cii er: S ^^) Date of inspection: pI/ sTTr E.���i tcs:. _ a_ O'__ ._ ` - - - - - - -- - - le r - - _- - iC - - - --_ �iaate ej?='aii /F rev[ M(A L-00, �o 6 - OC o 4 .1c 2 _ - - 4 Town of Barnstable OF 1HE Tp� Regulatory Services MSTABLF Thomas F. Geiler,Director 9� ib& ��� A,F0.19. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER A septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving the report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms. approved at a particular property would be listed on the Disposal Works Construction Permit. Q:\SEPTIC\Disclaimer Private Septic Inspections.DOC L oFINE T Town of Barnstable Regulatory Services Barnstable * e, Thomas F. Geiler, Director ;;m�eri� y snxxsrnst 9� . �0r Public Health Division 6,39 Argo Thomas McKean,Director 2007 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 29, 2007 Robert Williams 300 Main Street (Route 6A) West Barnstable, MA 02668 Regarding Septic System at: 300 Main Street, West Barnstable 02668 Inspection of System on: July 7, 2007 Certified Inspector: Mark Polselli *Must Comply Within: two (2) years Dear Homeowner: ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE: TITLE V The septic system located at the above address was inspected by a State of Massachusetts Certified Septic Inspector on the above date and The Title 5 Official Inspection Form submitted by the State of Massachusetts Certified Septic Inspector above shows that the system"FAILED" under the guidelines of 1995 Title 5 (310 CMR 15.00. You have two (2) years from the date of the inspection of system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health QASEPTICTonn Let Septic Inspect Fails Aug2007.DOC