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HomeMy WebLinkAbout0070 ACRE HILL ROAD - Health 70 Acre Hill Road Barnstable A = 297 - 064 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS . DEPARTMENT OF ENVIRONMENTAL PROTECTIO I bq� um TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A, CERTIFICATION . y Property Address: 70 Acre Hill. Road : Barnstable . c� Owner's Name: Sebastian Richer , ' Owner's Address: Date of Inspection:� sZ, V Name of inspector:(please print) W i 1 1 i am _ Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number:_(508) 775-8776 CERTIFICATION STATEMENT 1 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: l/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ,,1—'�.,., ---YA Date: ,I—AG— The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heaith of DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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 1 Page 2 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: '7.0 Acre Hill Road Barnstable Owner: Se Richer, Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. SZhe�avc Passes: not found an information which indicates that any y 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 repair d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answe 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 exfrltration 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 approvaal of Board of Health): broken pipe(s)are replaced _ obstruction is removed distribution box is leveled or replaced ND xplain: The system required pumping more than 4 times a year due to broken or obstmaed pipe(s).The system will pass spection if(with approval of the Board of Health): broken pipe(s)are replaced obswction is removed ND explain:� . Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 70 Acre Hill Road Barnstable Owner: Sebastian Riche Date of Inspection: , — o —a C. urther 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 fail' to protect public health,safety or the environment. I. ystem will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the iyslem 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 jCesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh . System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the ystem 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 front 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 acteria and volatile organic compounds indicates that the well is free from pollution from that facility and - e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other ailure criteria are triggered.A copy of the analysis must be attached to this form. 3. (her: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 70 Acre Hill Road Barnstable Owner: Sebastian Ric er Date of Inspection: (—6 D. System Failure Criteria applicable to all systems: You muk indicate'yes".or"no"to each of the following for all inspections: Yes No _ ackup 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 Stlatic 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%day flow ReAquired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ol'times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within I00.feet of a surface water supply or tributary to a surface %%jater.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 f et from a private watrr supply well with no acceptable water quality analysis. (This system passes if the well water analysis, Iperformed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from that facility and (lie 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 forma /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. L rge Systems: - To be onsidered a large system the system must serve a facility with a design now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The foll�.wing 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—1WPA)or a mapped Zone 11 of a public water supply well If you have lswcrediyee to any 1.question in Sertioa E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owrner or operator of wry 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 lys em owner should contact the appropriate regional office of the Department. 4 r Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 70 Acre Hill Road Barnstable Owner: Sebastian Richer Date of Inspection:_ �S - _G 'T Check if the following have been done.You must indicate`)es"or"no"as to each of the following: Yes No j ✓ Pumping information was provided by the owner,occupant,or Board of Health I/Wcre any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ` v 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? LIf 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 ✓ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of distance. is unacceptable)[310 CIAR 15.302(3)(b)) i 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 70 Acre .Hill Road arns a e Owner: Sebas ian Ricner Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):. Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#o bedrooms): 4 Number of current residents:Al Does residence have a garbag der(yes or no):A4q Is laundry on a separate sewage system(yes or no):�D [if yes separate inspection required) Laundry system inspected(yes or no): U Seasonal use:(yes or no):Ya'Water meter readings,if a tlable(last 2 years usage(gpd)): 10/0 4 to 4/0 5 — 5,000 Sump pump(yes or no):lheb 1 0 0 3 to 1 0 . 0 4 54,000 Last date of occupancy: N _3- r . u. COMM ERCIALhNDUSTRIAL Type of establis ent: Design flow(b ed on 310 CMR 15.203): gpd Basis of desi flow(seats/persons/sgft,etc.): Grease trap esent(yes or no):_ Industrial ste holding tank present(yes or no):_ Non-sani waste discharged to the Title 5 system(yes or no):_ Water ter readings,if available: Last d e of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ,� G Was system pumped as pad6f the inspection(yes or no): ° If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: T VP 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 co m onent date instalied(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no)-,(& 6 f Pagc 7 of I I OFFICIAL INSPECTION FOI01—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA1tT C SYSTEM INFORMATION (continued) Properly Address: 70 Acre Hill Road Barns a e Owner: Sebastian Ric er Date of Inspection: BUILDING SE ER(locale on site plan) Dcptlt below adc: Materials of onstruction:_cast iron _40 PVC_other(explain): Distance G m private water supply well or suction line: Comment (on condition of joints,venting,evidence of leakage,etc.): SEPTIC T /Idcatc ANK. on site plan) Depth below grade: I Material of construction:_concrete metal fiberglass polyethylene _odncr(explain) _ If tank is metal list age:_ Is age confimted•by a Certificate of Compliance(yes or nu): ccni _(attach a copy of ficatc) Dimensions.- Sludge depth: Distance Gom top of sludge to buttom of outlet ice or battle: Scum thickness:�Z 3 Distance from top of sewn to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or bathe: e f low were dimensions determined: �,/G� a ,/�: 2 I 4 ,oc L✓ Comments(on pumping recommendations,inlet and outlet tee or baf! c con"icn,structwal integrity,liquid levels as related to outlet invert,evidence of leakage etc.): GREASE TRAP: ocatc on site plan) - Depth below grad_ Material of cons Lion:_concrete, metal fiberglass_polyethylene`other (explain): - Dimensions: Scum thicknes . Distance [torn lop of scull)to top of outlet tee or baffle: Distance Got bottom of scum to bottom of outlet tee or baffle: Date of last umping: Conunent (owpumping reconunendations, inlet and outlet tee or battle cwnditivn,structural integrity;liquid levels as relate to outlet invert,evidence of leakage,etc.): 7 'age 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F0101 PART C SYSTEM INFORIIIATION(continued) Property Address: 70 Acre. Hill Road Barnstable Owner: SebastianRicher Date or Inspection: -Lg-65' TIGHT or 11jadc: DING TANK: (lank must be pumped at time of inspection)(locate on site plan) Depth below Material of nstruclion:�concrete_metal_fiberglass____polyethylene other(explaut): Dimensions. Capacity: gallons Design Fl�w: gallons/day Alarm prstscnt(yes or no): Alarm Ic�cl: Alarm in working order(yes or no):— Date of ast pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opencd)(locate on site plan) Depth of liquid level above outlet invert: Conunents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out orbox,etc.): PUMP C11ANI (locale on site plan) Pumps in work' g order(yes or no): Alarms in woro order(yes or no):— Com ments( ote condition of pump chamber,condition of pumps and alipurtenaaces,etc.): • Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 Acre Hill Road Barnstable Owner: Sebastian Richer Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: TypS/ v 1/leachtng pits,number:� 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.): ►J.z CESSPOOLS:—'(qcsspool must be pumped as part of inspection)(locate on site plan) Number and configufation: Depth—top of liquid to inlet invert: Depth of solids la er: Depth of/ogroundwater yer. Dimensisspool: Materialstruction: Indicatio inflow(yes or no): Commencondition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY/notc on site plan) . Materiaion: Dimens Depth o Commeition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 n OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 Acre Hill Road Barnstable Owner: Sebastian Richer Date of Inspection: 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. w d 3 3b 34 41 10 `Page l l of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 70 Acre Hill Road Barnstable Owner. Sebastian Richer Date:of Inspection: 5—,,L G_*> 57' SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water�?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 propertylobservation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 1,16 f - 11 TOWN OF BARNSTABLE LOCATIo SEWAGE VILLAGEf�(Z(.� uG,�I„� ASSESSOR'S MAP & LOT a INSTALLER'S NAME.& PHONE NO. ( `-W tCO SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Pap--CAST- AT-, (size) [ae6 .�L, NO. OF BEDROOMS PRIVATE WELL O UBL1C W R BUILDER OR OWNER `��pytircu-(�Ie1� DATE PERMIT ISSUED: 22 <-C'J°'�, DATE COMPLIANCE ISSUED VARIANCE GRANTED: Yes No 7/ X� 6 �' 7 5 o �`vim t )2,, 2-T! D Cp`4 l 4 3 r y /,_ � S THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ApplirFation for Uigp.ati al Work,5 Toustrur wtt i Dato Application is hereby made for a Permit to Construct ( ) or Repair ("-/an Individual Sewage Disposal System at: Location-Ad Tess ................................ .................... ...........Lot-No---•--............•-------.............--- .Owner s C. . 1 t.s_._... :..............--c ..P. . 1 _.5 � ®� . Installer Address Type of Building ,3 Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons............................ Showers Gr YP g ---------------------------• P ( ) — Cafeteria ( ) Pr Other fixtures -----•-----------------------------•-• . W Design Flow........`S _.......:...............gallons per person per day. Total daily flow____31.34�...........................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---L49(........ 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........................ �14 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ P4 --•------•----------------•--•-----•----•---------..........---------•--....._....................._......................................................... 0 Description of Soil............................................................................... --------------------------------------------- U ---------------•--------------------------•----...------------.....------------------•-••--•-•--•-------•--•-------------......-•--------------..._.................................................... 0 Nature of Repairs or Alterations—Answer when applicable._-_�Q Jal _l____:_� v__. ! ............... ice !ram` T_V' =h---------------------------------------------------------------------•------..._..---.....---........---- 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 be7i issued bv the bo rd of health. Signed �Ie� .:. ... Date ApplicationApproved By ............ ... ....... .t...............................................------------------ Date Application Disapproved for the following rearons- ..............................----------------------------------- --- - ------------------ ----------------------------- ------------------------------------------------ -- ----- -- ------- ----------............- ------------------------------- ---------------------------------------------------------------------- ------ ------------------- ¢¢ ....... Permit No. J... .- n�- �............................. Issued -... .......--- Date I �_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Application is hereby made for a Permit to Construct ( ) or Repair (`-)an Individual Sewage Disposal System at: Location-Address or Lot No. Address .............................. Owner � -----------------•-- . Installer V Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_.��......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons.......'..................... Showers ( ) — Cafeteria ( ) dOther fixtures -----------•••• -•-------------------------•-••......-•---•-••-••--------•--•-- -•-•--•-•-•-•----------•....---...........•--...•--•......-•••.--•- W Design Flow.........`'z .......................gallons per person per day. Total daily flow..: 31 _..__._....._._._._........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.... ry.._..... Depth below inlet... r......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) , Percolation Test Results Performed by................................•.........._..----------------------.----- Date........................................ W Test Pit No. 1................minutes 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........................ P4 •-•--•....•-•••••-•--••••-••-•------••--•--••-------------••-•••....------................-----••........................................................... Description of Soil I ....................................................................................... V .....................•-•.....••••-----•----...._...-••--------------------------•-•-•-----•---------•••-----•--•••-•••---•--•----------•----••--•-----•-•••-•••--............................-----•------ W --------------------------------------------------------------------------------------------------------------------------------••••. �:..---- U - Nature of Repairs or Alterations—Answer when applicable....-S - �. _C.�..._.I CR?_..a�-r 6. 1.7l_••__•_•_••_... ..................'�- .K.................................. l -T f .....�....1••..........-----------.....---------------------...------------............................. .... 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 ., .... ... ... `' . lo' . Date Application Approved By ............ .-�-�, ....�>--a cam ,-,-�-.7. G Date Application Disapproved for the following reasons- ..................................................------------------------- ---------------------------------------------......... ......................................---- --------------------------------------------------- -------- --- PermitNo. 1 _-.-a-7�---------------------------- Issued ........................................................Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired,(' L)- by------------------------------------- ...-t-_ t.( .. S t-ti. . 4 Installer / at ------------------------`7Q---------� --(Zr--- -------t-----------------... -----------..-�A --�"P----.........---------------------- has been installed in accordance with the provisions of TITLE 5 oA.The State Environmental Code as described in the application for Disposal Works Construction Permit No. --------....2.------�Z )--------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....-.. -----�n... 1J''-- ....... ----------------------------------------- Inspector --------------------------a----.......--•- -- -------------------..._........-----...- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....Zl'�� FEE..... Permission is hereby granted............ : N��.._CZ` /f--1................................................................ to Construct ( ) or Repair ( 4)-an Individual Sewage Disposal System at No......................:2 0....-•.)" � /�,-K- /J,//• )�- K 0_r1 r/137-,A ----------------------------------------•-•-•••.••••- Street C as shown on the application for Disposal Works Construction Permit No.o./�a.-7O.. Dated.......................................... f Board of Health DATE. �?--`' r .-------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 4mG.... �. no.avoi6 a•Y--I 1Y"oa.c.wu 4�8"��4vo. .riG6 vuv! ®� Yvio 16" 4 Y-So"w� I .... .a..,. � I � 4"ren.mue. I Y w an.Le o.o 3 I 1 o"rcn.rum I ggg� Y-Y.SO x.own 4av ova. � I C� x n F r.o. J.r ru -D auu:L4'41� r ao< b k 4 14� b 1 e q J ee.TE ertoro. a4u. Iq v, r F 4 ReAWonv 1 I N 7y k a— �.�. ° Jj a. a. S® �= Q 76 l l:. TJON S E W A`` PER 1T NO. M. 'VILLAGE.a97- I N S T A LLER'S NAME &F A.DDRESS /-/M. B U I L D E R OR OWN ER T 14 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 7-/1` , ' �° =3 _ '� ��, �- � 0 ® 6�.� � .. �� No..---.........S FED... �r ?1........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0 F... 1 r- -------------------_..................... r . pphra#ijan -fur Biipuoal Marko Towitrurtion Prtuit Application is hereby'made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal System at: .....� _CL�----��1 :�._�PrA-------•---.......-•--•-------•--...---•- ....................... TLocation-Addres rn or Lot No. ��Owner �l,s �y Adss W L, � (ZI• ►�.:. 4. .11Fs'. ............................ .................t Fdre........... ra ............ ._.. Installer Address d Type of Building Size Lot... � � ' ----Sq. feet Dwelling—No. of Bedrooms._..........................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ____________________________ No. of persons....... .._�.............. Showers ( ) — Cafeteria ( ) a' Other fixtures ...................................................... W Design Flow.....................__-�`�--------------gallons per person per day. Total daily flow...............5,60_ .__.___._.....___gallons. WSeptic Tank—Liquid capacityl ±S�_gallons Length_ '__ f�___ Width_ .` ------- lliameter................ Depth._.�'__5' 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.......:k...___-minutes per inch Depth of "Pest Pit------- Depth to ground water--------------------_-- ;lq Test Pit No. 2------ ......minutes per inch Depth of Test Pit........1.4'...... Depth to ground water________________________ Q+' --------------------------------------- ------------------------------------------------------------------------------------------------------------- - O Description of Soil------0__' 5 11---• f-o-- 4---- .Z 11� ►------61-."-_t- ..-•-LA_Y_ER2A---c*-----K DI m x �A,n�. � D----------------------------------------------------- U 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 Article XI 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 the board of health. Sign d-.---- ------------ Da----------------- .� _ Date Application Approved By-------f F - I- Z, l 1 -•-_-•j/— 7 : Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------•--------------------------•-------------------------------•--•••••-----••--- ------------------------------------------------- Date Permit No.................................._...................... Issued---.77-11�_-*7,8-_----------------- Date No......................... FEs... ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y., 1� .....-_.....OF..... C...... ...... Appliration -for Di poiial Workii Totuitrurtion Vrrniit Application is hereby'made for a Permit to Construct (/or Repair ( ) an Individual Sewage Disposal System at: •�-G2C---- �1 ...1�•-�ZOAp----•--------------------------•----•----- ---------------LC�T •-•-----------------------------•---....----•-._ CC J �EJ Loc�at�ion-Address (Zt�lsT A 6LC or Lot o. ........--•--- - ,....� ... i�. ------------------------• -- --------------------------•------------------- Owner Address W UE�OS..IIJO fJT_ _.. RUSTA�LC' ,-� --•--------------- ------------........_._...------......-•••-••• ---------•------ Installer Address Q Type of Building Size Lot... 3 R _ !-....Sq. feet Dwelling—No. of Bedrooms------- -----------------------------------Expansion Attic ( ) Garbage Grinder ( ) `L Other—Type T e of Building ____________________________ No. of persons ___-__ Showers —p� yp g p -� _______-_ ( ) Cafeteria ( ) Q' Other fixtures _________________________________ _ W Design Flow______________________a3.__..____.._.gallons per person per day. Total daily flow..._._.._____._3 �___.___-__-_-...gallons. WSeptic T,-Ink—Liquid caacity1-Q-.gallons Length_--- Width--` '-_-!S?I-`- Diameter................ Depth-_- x Disposal Trench—No._'_:.......:....... Width-------------------- Total Length.................... Total leaching area....................sq. ft. 3 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 Nd. 1...... -------minutes per inch Depth of Test Pit------- ______ Depth to ground water......................... f14 ( Test Pit N'o. 2...... ______minutes per inch Depth of Test Pit-------- ` ------- Depth to ground water-_-_--_--____-____-__- p � _ II Description of Soil ---------------{..-� 1�1 �� � 5 11�. + 10__-..� 8 . ,-(1 i S O>r M�-DIU-tJl cx� 1- `aJA--------•------------•------------------------------•----•----------------------------------------------------------------------------------------------- } = x..---------------------------••-------•------------••---•-------___-------------___------_______,_----------------_---•--•-------------------------------- U Nature of Repairs x •- ::....» or Alterations—Answer when applicable-------------------......................-----------------•_-................................... ------- ...........,� --f----------------•------------ =----------_.-_____- -----__--_---------------•----- --•----•------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI'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 the board of health. Sig: d . ------------------•-- .........---------------------- Date Application Approved BY /r ...fit.. -------------------------- ---�-_/%— �' .------------ q r 'l L Date Applieation`DisY`Fo'ved for the following reasons-----------------•-__---__-------,--_--------____________--:-----------------___-------------------_____--------- Date PermitNo.------•---•-•-•----------•---------------------------•-- Issued-.------------------------- -............................ Date j THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........la.SOP..............OF..... t2t�S"�.At�L�-.................-..-.-............ �rrtif iratr of 0,11mphaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( v4r Repaired ( ) by..... K 10e_t_QQ----.'�2o_�_N ------------------------ ('�,� Installer at.......=Q�---..1� �C.{ZE 41 LL I .Opp LD---_ ---�����•����---------------------- ......................................... has been installed in accordance with the provisions of A XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No___________________ ---- dated --_�'""«*T-t------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................---------------------------------------•--- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH y; 6' .............Lo.w.>`1............OF......6P(1R s7.-A..e>.LE.-..................................... No......................... FEE---....------•------•-- �i> >a�tt� larks �lQ�ctrrti> t� Vrlltit Permission is ereby granted__...uG_.�0_f-1� ____ '2e_�-NC!2S to Construct ( or Repair ( ) an Individual Sewage Disposal System at No...LO V1--- e 1- 1. UA� -�t 2-�1s-! AL LC --- Street as shown on the application for Disposal Works Construction P _ ' .................:��"-� - L____:d _& ----------------------------- DATE--------- _ S Board of Health ------ ---------------- ---------•--•-------------------•---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . . +sn"`°"^." a',rn.`x' 'Q'p? •n'n. ,":�"?'..+;t Y- _ •P �;..f=^'t. _ :e-tT I -!r w' zry - • � • LOT l(oTE7,ST HOLE - • 3 50.49 `- s OCT. Z7� /97? .Xofo �.. 34 aa►t LOT 17 0, PAUL MURRAY NSAEC T'pR PESeRvs A 444,3784 L-EAC.H at 't'LOT 2 1�6 EL€fit. e2/; z i FPT/L q N a O>3& ` LOAM _ • �19 D �<C Mau - - t 154= aa�5 a {g �►�$ Cl. # AND SUBSOIL s � - EX STIN& rE ST C5 36 °/68 LAYERS 1 F-ouli8ATION NoCE `lf r 15;_'t ; 3a' F/NE SRiV D ! 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