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HomeMy WebLinkAbout0428 COMMERCE ROAD - Health (2) r r �428 � , i ,ROAD - yK C011 IlVIER B Ntable k r ; r; o - s v' - Commonwealth of Massachusetts ++Romf� Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -'Not for Vol untary.Assessments,.> Yt .; i- � �Cr 428 Commerce Rd Property Address 7 Elise Rose ' Owner Owner's Name , information is -r� required for every Barnstable MA 02630 7-12=17. 9 m; page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any it way. Please see completeness checklist at the end of the form. A. General Information s/ / p.yq/ r ,1. Inspector: { ' r tx, ' Shawn Mcelroy `a _ .F �, +: fiir'. Name of Inspector 4 Upper Cape Septic Services ; Company Name - P.O. Box 73 t J1. Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification t I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper'function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of ; Title 5 (310 CMR 15.000).The system:" ® Passes. f rq Conditionally Passes: .; ,.,f .�a❑ Fails. ,, , . ❑ Needs Further Ev atqation by the Local Approving Authority... 7=12=17 Inspector's Signature: N . . - = Date The system inspector shall submit'a`copy of this"inspection report to the Approving Authority (Board of Health or 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. ****This report only describes conditions at the time of inspection and under the conditions of use w at that time.This inspection does not address how the system will perform in the future under ` the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 7 andf11( YJ Commonwealth of'M+assachusetts r ar. 01 Title 5 Official Inspection Form R 'Frti I�I Subsurface Sewage Disposal System Form -Not for•Voluntary Assessments 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) r Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts =1 , Title 5 Official Inspection- Form .� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments.. <y. 428 Commerce Rd Property Address Elise Rose Owner Owner's Name - { information is ' required for every Barnstable MA 02630 7-12717 page. City/Town State Zip Code Date of Inspection r B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ` Y El Observation of sewage'backup or breakout or high static' water,leveltin the distribution box due to broken or obstructed pipe(s) or due to a"broken, settled or uneven distribution box. System will pass inspection if(with approval of Board'of Health): ❑ broken pipes) are replaced '' "`" ❑rY, ❑ N ❑ ND (Explain below): = obstruction is removed "` ° El Y .­El' N ❑ ND'(Explain below): .fj o.a '" IN. t la.,. .t• , ry: - El distribution box is leveled.or'replaced ` ❑ Y' `T❑ N ❑ ND'(Explain below): „ .. _ c "ki n.�,: .. }". - r..i :,,it ». �.• .. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ brokenpipe(s) are re laced ❑. Y ❑ N .❑ ND (Explain below): P ( P ) ❑ obstruction is removed- ❑ Y ❑ N ❑• ND (Explain below): C) Further Evaluation is.Required by the Board of Health:- Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1: §yytem will pass unless Board of'Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment:` x ❑ 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 t5ins•3/13 v ^:. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - f Title 5 Official . Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system SAS and the S y p p y (SAS) AS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system-has a septic tank and SAS and the SAS is within 50 feet of a private water supply well ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form F �I Subsurface Sewage Disposal System FormNot for Voluntary Assessmentsr, 428 Commerce Rd 1 9 4 '✓ Property Address _ Elise Rose .a Owner Owner's Name information is Barnstable MA 02630 7-12-17 required for every ••- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No. ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ . - ®., Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to'a surface water supply. . ❑ E Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This -system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a,design flow of 2000gpd- 10,000gpd. - 0 ® 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 y ; necessary to correct the failure. ' E) Large Systems: To be considered a-large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. .. fir:. .F • ' ;For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. y • ; t. �- Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply F ❑ ❑ the system is within 200 feet of a tributary to a surface,drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area=IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the I system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts 1a=1 Title 5 Official Inspection Foem Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No El - ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ . ® Have large volumes of water been.introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site,inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310'CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form k+ - �N Subsurface Sewage Disposal System Form-Not for Voluntary Assessments + I 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is Barnstable MA,, 02630. 7-12=17 required for every '• • page. City/Town _ State Zip Code Date of Inspection . , D. System Information - Description: • Number of Current residents: f. ; Does residence have a garbage arba a grinder?,It, r ❑ Yes No Is laundry on a separate sewage system?;(Include laundry system inspection Yes ® No information in this report.) , y .Y Laundry system inspected? r, +' ,, t ❑=,Yes ® . No,. Seasonal use? ;. � Y ra. ❑, Yes No Water meter readings, if available (last 2 years usage (gpd)); = Detail: 4 Sump pump? ,�:• .•w.k, ;, t' r��' r❑ Yes Z 'No } Last date of occupancy: Date t .. ,` �• � Date . Commercial/Industrial Flow Conditions: r,:• ; , `y . Type of Establishment: - ". Design,flow (based on 316 CMRd15.203):1 Gallons per day(gpd) -Basis of•design flow(seats/persons/sq.ft.;`etc.): 4" -.`I r}'. 't:I i Tr �..V,t < - Grease trap present?',, ❑ YeSL ❑ .No-.% - Industrial waste holding,tank present? . :;' - - ❑ Yes ElNo Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts 1h f Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use:' Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: L gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil.absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts a=1 f Title 5 Official lhspection Fora ' y Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments 11 +, ;f! 428 Commerce Rd n +: x. Property Address Elise Rose Owner Owner's Name " Y information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) , Approximate age of all components, date installed (if known) and source of information: 1979 Were sewage'odors detected when arriving at the site? F ,;,❑ Yes ® No Building Sewer(locate on site plan):_ 18" Depth below grade: a, a ;: ,., . .a .:<, , ' feet Material of construction: , ` ®cast iron ° • ® 40 PVC J 0 other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting; evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan):. 12" Depth,below grade:. feet" t M Material of construction: ',, ,�• ® concrete ❑h metal ❑ fiberglass polyethylene - ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ; ,❑ Yes ❑ No Dimensions: 1000 gal l: Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Il _ � Commonwealth of Massachusetts aa fi�a Tittle 5 Official Inspection Foam l=' 'r'I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is Barnstable MA 02630 7-12-17 required for every ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle , 20" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" , How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts :► a �r£Y. y t Title 5 Official Inspection Form 1.+ �I Subsurface Sewage Disposal System Form -`.Not for Voluntary Assessments _a __xu '�,`�.,¢.✓ 428 Commerce Rd Property Address . Elise Rose Owner Owner's Name N T information is Barnstable MA 02630 7-12717c. :s'• required for every • '' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) t - 17 4 4 } Comments (on pumping recommendations, inlet and outlet tee or baffle,con_dition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ' A Tight or Holding Tank (tank must be pumped at-time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - Capacity: > gallons• _Design•Flow:: gallons per day ' Alarm present: ' ❑ Yes ❑ No , Alarm level: , Alarm in working order: ❑ Yes ❑ No Date of last pumping: - Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts i a Title 5 Official Inspection Form J.I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � ! 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pit. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No*. Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts „ 7: a=1 Title 5 Official Inspection. Form .1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 428 Commerce Rd Property Address Elise Rose ._ ; :4 Owner Owner's Name information is required for every Barnstable MA. 02630 7-12=17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: _ ® leaching pits number: • 1-1000 gal ❑ leaching•chambers number: - - ❑ leaching galleries number: ' ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: *• - �, 1:1 • 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.): Leach pit in good condition and empty at inspection with stain line at 24" below inlet invert. _ Cesspools (cesspool'must be pumped as part of inspection) (locate,on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts �a=1 Title 5 Official Inspection Form „hI Subsurface Sewage Disposal System Form Not for Voluntary Assessments a� 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition 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 of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspe ction Form { E 'il .Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments • 428 Commerce Rd Property Address Elise Rose f Owner Owner's Name information is Barnstable MA 02630 7-12-'17 required for every - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ~ ❑ drawing attached separately _ -313 +r { ,eo n . „ 13 lig 01 30 Y C '6 35 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts P21f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,r. 428 Commerce Rd Property Address Elise Rose Owner Owner's Name information is required for every Barnstable MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts as Title 5 Official ,Inspection Form TSubsurface Sewage Disposal System Form Not for Voluntary Assessments _ _, -v . • 1 ,•�f%g 428 Commerce Rd Property Address Elise Rose Owner Owner's Name F. information is required for every Barnstable i MA 02630 7-12-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ®. Inspection Summary: A, B,`C;D, or E checked. ; ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed , ®' System information.— Estimated.depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate fileZ. " ef . / • . - .-. a !• F ', a f' •. .. t5ins-3113 " Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 1 N BAsT .>~ a 17 1,OCp�' ON C SswAG>F - INSTf?.1�.�'R'S NAML do THOME NO.' ' a L15ACIIING 1�/�C�.TE°Y ia) 7777. SYJI1(:I��ER tR C9�l �t FEFtIVsg'��21'IE 3�pshrataon i�iseun�l3stv�e�a�e � �, Nl�xlit�um AcljasW GOuRdwacer l' le W the��ttom al�rach0n� PklvaBc. 4CAtcr:;uppCjr i�Jci tsu Y„t ► iais�g F masy vF19s exist g tit seta or.w�thin�Op feot oi't�seetu�g f�GUt}') Ec1L a �►let�s;nd said 1.esicEun�gas;►liy� �y a«tlancis exist Lee ;1+il�hss�":iOQ;fc:etpk lcuc�sfpg�'Actlitya : � 1Pusnt3hc�"tiy r G f _y-Q,` y c 14 . 13'6` A -3- 1(. , 93- 30" Z 079 LOCATION SEWAGE PERMIT NO-�;� d`ILLAGE r ASSESSORS MAP NO: 17 Vyt WC �D : YVI PARU Nn- )at I N S T A LLER'S NAME & ADDRESS —06 9&se S64 CMI A �b2 Tom- gT. S:p L -Q J;AS S t A-4 BUILDER OR OWNER DATE PERMIT ISSUED c7 DAT E C 0 M P L I A N C E ISSUED Cc /b2 /,� � �e 6 S -mmiz— a �xP L Co wt wt ��2 cC ' PT) N F��... ...... ;: THE COMMONWEALTH CyF--MA.SACHUSETTS - BOARD OF HEALTH ...... ... .. -- -_----OF...... ........................• --...--......--------.................... Appl#ation -for 43topwial Works Touti#rurtion Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at I Loc on-Address s/q /s� _I or iy,Ig No. kC ..____ !_.�.R...................• 4 ..._1Y / -____ 'Y.__-`-l..!----___. ....... Owner Address �,.� Installe Address ¢; Q Type of Building �' _ Size Lot............................sq. feet U Dwelling No. of Bedrooms----=_--- __________________________Ex ansion Attic Garbage Grinder Other—Type of Building _--________________________ No. of persons.--_____--_______________-__ Showers ( ) — Cafeteria ( ) 1 /1. Otherfixtures .--------•--•-•--•-•-----•-_---- ---------- - - - --------•-••-•---------------------------•----•- -•---•----••--•----.__.,.-;-----;:. D,�%`o Design Flow______/,e-Z ___________________________gallons per-person p--1 day. Total daily flow______________.___..__.._.... ....._.gallons. WSeptic Tank—Liquid capacity/ 0-gallons Length._cg......... Width----- Diameter________________ Depth___r�__ _:____. Disposal Trench—No_____________________ Width...........f___-___ Total Length.................... Total leaching area--------------------sq; ft. x Seepage Pit No.___ ___ Diameter_[®t_�__ De th below inlet__-6O�f' Total leacliin tre:. P g � Z .. 1. ft. z Other Distribution box (� Dosing tankJ� Percolation Test Results Performed by-k�__..! -___._ _ __F......' !`? 2______________ Date_-. , a . Test Pit No. 14.___ _minutes per inch Depth of "Pest Pit1$.Ia.!___. Depth to ground w tPr..._"'Voti _. LL Test Pit No. 2 _ _._minutes per inch Depth of Test Pit./$jP _.... Depth to ground waterA�00++L'_ re a' 2r/ ------------- ---------------------------------------- ----------- y------. L . mob -.�------- Description of Soil-----� 3 --------- � - •._..--=- �--. �, ----- F-------------------- -" ..........................................................• - •-•-- •... -----•--. p v a 9^e�®Y ! � A ---- - -l - -- ----Z -- . .__. _ e- 0 �G e .®' U Nature of Repairs or Alterations Answer when applicable._.�oo__��" -� _tlG- -_lfl�'�� :_ %9^� ------------------•-------------•-- - �------- h Agreement x 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 iss y the board of t Signed-• - •-------- •-- ---. --------• ----------•-----------•--------- ,. Date Application Approved By------4441-11 - ------------------- ---- --- -- i�n - 7`"------- Date Application Disapproved for the following reasons:.........................................................—..................-----•--------- ----•-.__-__-- ------------------------------------------------------------------------------------------------------ Date PermitNo......................................................... Issued........................................................ Date l `�- --- ---- ------- - --------------------------------- _ N -- •=---- �.. a FEs.............................. THE COMMONWEALTN,_OF .MASSACHUSETTS . BOARD OF HEALTH ..........OF.................................... ..... Apphration -flax Miiplagtti Workii Tomitrurtto ' Vrrutit Application is hereby made for a:Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at Locatio Address o t No. Ow '. Address ------------------ Installer,,,, Address UType of Building Size Lot-------------------- q. feet Dwelling—No. o Bedrooms, :-------- ----------------------------Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building No. of persons---------------------------- Showers ( ) — Cafeteria ( ) P I Other fixtures .. ----- -4FDJZii�,y W Design Flow..........mil®..............----gallons per-pe&- peter day. -Total daily flow-- ---_-----------------------,_---._...gallons. WSeptic Tclnk—Liquid capacitr `_gallons Length.-..R........ Width___--Y--- Diameter------ --------- Deptll-- ------.". x Disposal Trench,—No_ _____________ ....... Total leaching area_-------_-__"___-_-sq. ft. Seepage Pit No ..__I-_-__-_-- Diameter....../9-1.S Depth below inlet_._--�---®...... Total leaching rea.28�- -sc. it. z Other Distribution box (vY Dosing tank ( ) 58� G5���7"' Percolation Test Results Performed by--- wN...__<!¢,��----4�__e4.6fz__.....___. Date---- _.--------------- Test Pit No. 1",�._.z,_:___minutes per Inch Depth of Test Pit-�_-__.:__-_-. Depth to ground wat r-/Ja-------------- (� Test Pit No. 2_ _Z._.minutes per inch Depth of Test Pit-4S '_"--- Depth to ground water®vv7PZd / Y •... D Description of Soils-� --'.. o.�i�s `� Soie. cam'. G,`�^ G -------- -------------------- <' v ..................... o � �y..=.3.&----------'�6v,_--,,-f^�--, -oq=- ---------- -------------- �- �.' Fes, c�. ! ------------------------------------------------------------ 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 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 i by the boa#ofal. tS - ..._..----- =-------------- e A lication Approved B -'"' ' 9` PP PP Y ' •••-•• -. - --- -- -------- Date Application Disapproved for the following reasons----------------------------------------------------------- `. ..---- Date PermitNo........................-------- '--------•----- Issued-----------------------------•----•---•---••---.._-..__ --- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ............ . ... .......O F..........-..........:.. ......................................................... frttfiratf of 10JIllutphattrf T I S 'O,4CER- , Th he Ind i ual Sewage Dis al S tem constructed ( ) or Repaired ( ) by b. -------- fJ -- ------- at.............................. ------ -----•-- -•----- -- •' �n�al er/!� f •"✓ --- L ........ has been installed in accordance with the provisions of _ X�off The State Sanitary C cle s dA --bed in the application for Disposal Works Construction Permit No.- ----------------------------------- dated-------. -----�-', /_------_--_______- THE ISSUANCE OF THIS CERTIFICATE ;SHALL N91'TBE..CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--6.k ' .�.'� ` >......'... . ---------------- --- -• Ins ecf ti THE COMMONWEALTH OF MASSACHUSETTS M, BOARD F HEALTH 67 ..................... ....................... No......................... FEE - �i� r Qla trurtiott � Pe'rmissi �jshherreby granted - ----- - .................................... to Construi r Re`ai�>;_{(. ')/ . ivi al Se a sp m at No.v` � --E`-" ------ ---- ........... --/- -- ----- as shown on the application for Disposal`Works Constructio e it Dated_."-A"7�'................. l } ',' oard of He It DATE. ---------------- s FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS kr EVERETT H . HINCKLEY ,{• -"' 42 STANOISH WAY •''� WEST YARMOUTH, MASSACHUSETTS 775-4979 REGISTERED LAND SURVEYOR REGISTERED PROFESSIONAL ENGINEER Re,.;- septic. system on lot on corner of" cQ ,nerce road and route #6A Mir Maul Murry Town of Barnstable Health Department Hyannis Mass, Dears lair Murray I.have inspected the septic system instal&dd7 at the: above address and find it 'complies with the plan drawn .for this location, Yours truly Everett H.Hinckley .?P.E. N s Ij .t October„ iS 19,79PA "•.. { A y:.- n,t+ {t [_•y r h H r L �'.'♦ '• ,.d -Aj- ' Eugene S, ivis a:y r .d. i r.. •t c .R BOX! 569 t" fi11 t South Dennis;. N1A. ."02660 °pear Mr. Syl:viat 'your, sewage'`system at Lot, l0,`: Commerce R, d' 'Batruttable was y `k w insspectad 'On 0 tober, '17 - 1979, i'by. Rorisld Gifford, Health Inspector;for the Town of Barnstable ,• In order for tus�: to'-' i8sue-Aa ,dert3ficate of; 'tcompllianCe,. .We require then installer to submit "two' completed ` te�in cards �. ,r ;hone: to 'be,'returned •torus,rYand kone,g3.veri: t0 .the oWiler° of the { pjrope ty a we, are-,-,` enclosing two,~.cads_ for:'your_,use:. a , We.�ire}-also enclosing an instruction sheet Upori receipt of :the cards, 'the complianc® ;wil .'.be mailed :toy { Very truly ,yourx , F ..�. }' - �'� ;'. ,� ., ,'„tom."'- f .. P � xa A •.� e;t rw 4� � x^i ,r• S q s Ronald-A•,xGiff®rd - f ..Health- Inspector fr Fi RAG/mm w , LL LOCATION - SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME & ADDRESS B U R D E B OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED J, i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................Y'—&-W- 111---OF�.......... Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Location-Address or Lot No. Owner Address Installer Address Other Distribution box Dosing tank 76 --------------- The undersigned agrees to install the aforedescribed Individua ewa e Disposal System in accordance with the provisions of Article XI of the State Sanitary Cod The under igned rther agrees not to place the system in oduae Ds' operation until a Certificate of Compliance ahas e i s ed by bo rd talth. ig Date 7_ 41 Date --'---------'----------'-----''---------------'—'—''—'—'--------'---'-----'—'- oat" PermitNo......................................................... Issued........................................................ Date ------------ No........... Fps... l).................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l�2✓1 1...0 F............ ..G ............................. Appliration -for Di ipwial Marks Tonstrurtion Prruid Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: / i _ y .. .. .� J^� ►. �l C.^ . G �.y 0�1r1 ! �L � . l.• L... /__...r!t.._ ••••_`� Location.Address or Lot No. ..-•--••--•-----------•-----------------------•--..............-----•-•--------•-•----------•----- ---•-----•-------•---------•••--...•----•--------•--•.....---••--•---•----•------•------------•-•- owner Address L? -••---••---- Installer Address U Type of Building Size Lot.a j.................. feet Dwelling—No. of Bedrooms----------'---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures w Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank-A Liquid capacity.JK4_.�gallons Length................ Width................ Diameter___._...._.-___ Depth----------- x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area..------------......sq. ft. Seepage Pit No.......I------------- Diameter---!_r---- v Depth below inlet__________ _ A.__. Total leacliin a ea......-.-..-____.-sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - D/j_ 3- / f � aPercolation Test Results Performed bY--•----------------------------------•-------------------- --- Date............. ------------------------- ,� Test Pit No. I................minutes per inch Depth of Test Pit-............. Depth to ground water......------------------ f� Test Pit No. 2................minutes per inch Pepth of Test Pit.................... Depth to ground water__.._.__.__.____-.------ Descrtption of Soil . (-- AA------`----'="-�` ' ----••--•------------------ - `�'`(-`� 1 x q- � / � cam.._ ,� �--��. _ w UNature of Repairs or Alterations—Answer when applicable................................................................................................ -------------- ------------------------------------------------------------------------------------------------------ ............................. -•------------------------------ --------- Agreement: The undersigned agrees to install the aforedescribed IndividualiSewag Disposal System in accordance with the provisions of Article NI of the State Sanitary oder--The undersigned rther agrees not to place the system in operation until a Certificate of Compliance has ee:t is ued byboa d o dalth. - - - ------------- ------------------ ------------------------------- Date Application Approved BY------------ �------------ •-•• - -- - - Date Application Disapproved for the following reasons---------------------------------j_____._.__.._.___..._....................---.....___.____. ....--------__ ---••---••-------------------------------•..............................................................--------------------------------•-------------------•-••-----------------------•---•-----.----- + Date PermitNo......................................................... Issued--------------------- ................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ....O F.............. .. .....�.�'U......c-w...................................... �rrtifiratr of Tlimplitttur b THI, IS O CE FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Y ������ = f( _ -------- --i i nstaller -I -----/ - ------------------ has been installed in accordance with the provisions of Ar c` ? I of "je "state Sanitary de as described in the application for Disposal Works Construction Permit No... _._a_6_ ________.____ dated....�..".......Z:...... G.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... � �-------------�.......-•-••-•---••---.. Inspector....--- - ............................. THE COMMONWEALTH OF MASSACHUSETTS 7(, BOARD HEALT No............. F %Vivolig Permission is h reb ranted �__L/.... to Construct . � ner ( rn Individual 6,a --'Disposal System at No.. ° .e!T - /' Street as shown on the application for Disposal Works Construction Per pat U/ ,( C� ------- -- ---- .................................. DATE---------------------------------------1-�--------------------------............ Board of Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / � LI DATA i c _ � IL • } n I /�I 5 L r >o .� o r ro OA -.,o / o r �/o rE ��C Av�►T cT 4 c c_ s`1 J� ey Ec. ZS S 35=o o Yz _ _ G�/Tom/-� •a ,�''.9.r'�/ V S �'f ,f0 — Ec. =Z3•S le S 30 ,32•Jr SE��'i C. .. .1'.�' 7 7f..'� CE.S�Cs/ /7`, 59 ..7.0 c.i�/.�unJ Or,OG'• ! .S.v1z.Js�- / ZC.r __— ✓. �; /YlEvi✓�` / .s loiv' — GL. 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